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Circulation. 2014 Jun 10;129(23):2380-7. doi: 10.1161/CIRCULATIONAHA.113.006855. Epub 2014 May 5.

Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes.

Author information

1
From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.). anupambasuray@gmail.com.
2
From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).

Abstract

BACKGROUND:

We hypothesized that patients with heart failure (HF) who recover left ventricular function (HF-Recovered) have a distinct clinical phenotype, biology, and prognosis compared with patients with HF with reduced ejection fraction (HF-REF) and those with HF with preserved ejection fraction (HF-PEF).

METHODS AND RESULTS:

The Penn Heart Failure Study (PHFS) is a prospective cohort of 1821 chronic HF patients recruited from tertiary HF clinics. Participants were divided into 3 categories based on echocardiograms: HF-REF if EF was <50%, HF-PEF if EF was consistently ≥50%, and HF-Recovered if EF on enrollment in PHFS was ≥50% but prior EF was <50%. A significant portion of HF-Recovered patients had an abnormal biomarker profile at baseline, including 44% with detectable troponin I, although in comparison, median levels of brain natriuretic factor, soluble fms-like tyrosine kinase receptor-1, troponin I, and creatinine were greater in HF-REF and HF-PEF patients. In unadjusted Cox models over a maximum follow-up of 8.9 years, the hazard ratio for death, transplantation, or ventricular assist device placement in HF-REF patients was 4.1 (95% confidence interval, 2.4-6.8; P<0.001) and in HF-PEF patients was 2.3 (95% confidence interval, 1.2-4.5; P=0.013) compared with HF-Recovered patients. The unadjusted hazard ratio for cardiac hospitalization in HF-REF patients was 2.0 (95% confidence interval, 1.5-2.7; P<0.001) and in HF-PEF patients was 1.3 (95% confidence interval, 0.90-2.0; P=0.15) compared with HF-Recovered patients. Results were similar in adjusted models.

CONCLUSIONS:

HF-Recovered is associated with a better biomarker profile and event-free survival than HF-REF and HF-PEF. However, these patients still have abnormalities in biomarkers and experience a significant number of HF hospitalizations, suggesting persistent HF risk.

KEYWORDS:

heart failure; myocardium; ventricular remodeling

PMID:
24799515
PMCID:
PMC4053508
DOI:
10.1161/CIRCULATIONAHA.113.006855
[Indexed for MEDLINE]
Free PMC Article

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