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Predictors of “relapse” after improved ejection fraction in patients with heart failure
Session:
Painel 1 - Insuficiencia cardiaca 5
Speaker:
Ana Fátima Esteves
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Ana Fátima Esteves; Rita Marinheiro; Marta Ferreira Fonseca; José Maria Farinha; Antonio Pinheiro Cumena Candjondjo; Joana Silva Ferreira; Sara Gonçalves; Tatiana Duarte; Nuno J. Fonseca; Rui Caria
Abstract
<p><em>Background</em>: Patients with systolic dysfunction that improved/recovered left ventricular ejection fraction (LVEF) present a more favourable clinical profile when compared to patients that maintain dysfunction. However, little is known about the characteristics of patients who “relapse” after LVEF improvement.</p> <p><em>Purpose</em>: Evaluate prevalence, clinical characteristics and outcomes of patients in whom ejection fraction declined after previous improvement.</p> <p><em>Methods</em>: We retrospectively studied patients followed at a heart failure (HF) clinic with left ventricle systolic function improvement after an initial diagnosis of HF with reduced ejection fraction (EF), which was defined as having an LVEF >40% on follow-up. We then evaluated the presence of LVEF “relapse” in these patients – a decline in LVEF to <50% or <40%, in cases where it recovered to preserved EF or to mid-range EF, respectively.</p> <p>We analysed patient demographic factors, previous medical history, medication, echocardiographic parameters and outcomes. We used logistic regression to assess the predictors of LVEF “relapse”.</p> <p><em>Results</em>: 98 patients were studied, 70 (71%) male, median age 69 (58-76) years.</p> <p>Patient characteristics are described in Table 1.</p> <p>In this population, 54 (55%) patients had recovered EF (>50%) and in 44 (45%) it had improved to mid-range values. In 36 (37%) occurred LVEF “relapse”: in 10 (10%) patients to an EF 40-50% and in 88 (90%) to an EF<40%. Ischemic cardiomyopathy and non-ischemic dilated cardiomyopathy were the main HF aetiologies (38% and 35%, respectively). 36 (37%) patients had a previously implanted cardiac electronic device, 17 (17%) an implantable cardioverter-defibrillator and 21 (21%) a cardiac resynchronization therapy device. During a median follow-up of 7 years, 39 (40%) patients had at least one HF hospitalization. Global mortality was 30%, with no significant statistical difference between the two groups.</p> <p>In univariate analysis, HF duration, type 2 diabetes <em>mellitus</em>, left main or left anterior descending coronary disease, valvular heart disease and chronic kidney disease predicted LVEF “relapse”. In multivariate analysis, type 2 diabetes <em>mellitus</em>, left main or left anterior descending coronary disease and valvular heart disease were the only predictors of LVEF “relapse” (Table 2).</p> <p><em>Conclusion</em>: In this group of patients, LVEF “relapse” after it had initially improved was frequent and was predicted by the presence of type 2 diabetes mellitus, left main or left anterior descending coronary disease and valvular heart disease. Despite improved systolic function, these patients remain at high risk, thus the need to maintain treatment.</p>
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