SPC365

Heart failure with recovered left ventricle ejection fraction: can we predict it?

Session: Posters (Sessão 3 - Écran 5) - Insuficiência Cardíaca - Clínica
Speaker: Bárbara Marques Ferreira

Congress: CPC 2023
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.6 Acute Heart Failure - Clinical
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Bárbara Marques Ferreira; Otília Simões; Paula Fazendas; Ana Rita Almeida; Sofia Alegria; Ana Rita Pereira; Alexandra Briosa; João Grade Santos; Mariana Martinho; Diogo Cunha; João Luz; Nazar Ilchysnyn; Oliveira Baltazar; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#201f1e">Background:</span></strong><span style="color:#201f1e"> Heart failure (HF) </span><span style="background-color:white"><span style="color:#212121">patients (pts) with recovered left ventricular ejection fraction (HFrecEF) are a distinct population of HF pts with different underlying etiologies, comorbidities and outcomes. Improvement in left ventricular ejection fraction (LVEF) leads to better quality of life, lower rehospitalization rates and mortality. However, little real-life data is available regarding the pts with improvement on LVEF.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#201f1e">Aim:</span></strong> <span style="background-color:white"><span style="color:#212121">To analyse the clinical characteristics of pts with HFrecEF and identify predictor variables of LVEF recovery.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#201f1e">Methods: </span></strong><span style="color:#201f1e">Single center retrospective case control study that included all pts</span><span style="background-color:white"><span style="color:#212121"> with HF with reduced ejection fraction (HFrEF) referred to heart failure outpatient visits from July, 2011 to January, 2022. Pts were divided into two different groups: Group 1 &ndash; HFrecEF pts, defined as LVEF&ge;40%; and Group 2 &ndash; HFrEF pts, defined as LVEF&lt;40%. Clinical and imaging data were collected, as well as data concerning treatment options.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#201f1e">Results:</span></strong><span style="color:#201f1e"> The cohort included 278 pts (76% male, mean age 60.9&plusmn;11.8 years). </span><span style="color:black">Baseline characteristics: 59.7% had hypertension, 59.3% smoking habits, 47.8% dyslipidemia, 32% diabetes, 29% clearance creatinine </span><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">?</span></span><span style="color:black">60mL/min, 85.3% were in sinus rhythm and 28% had left bundle branch block (LBBB). Concerning the etiology 41% had ischemic dilated cardiomyopathy. </span><span style="color:#201f1e">The initial mean LVEF was 26.7&plusmn;6.7%, 29.8% had at least moderate mitral regurgitation and 31.3% had also right ventricle dysfunction. Initial NT-proBNP median was 1513 (IQR 2401) pg/mL. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:black">The ejection fraction recovery rate was 46.4%. In the univariate analysis, the pts that recovered </span><span style="color:black">LVEF had less ischemic etiology (p&lt;0.001), lower </span><span style="color:black">initial (p&lt;0.05) and final NT-proBNP (p&lt;0.001), more presence of LBBB (p&lt;0.05), were on maximum dose of ACEI/ARAII (p&lt;0.001) and beta-blockers (p&lt;0.01), and had more previous (p&lt;0.05) and less late HF hospital admission (p&lt;0.001). Further variables were analyzed but no differences were found between the groups (Table 1).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The logistic regression identified two significant predictor variables of LVEF&gt;40%: lower final NT-pro-BNP OR 0.10 (CI 95%: 0.03-0.35) and target dose of ACEI/ARAII OR 2.7 (CI 95%: 1.4-5.1). On the other hand, ischemic etiology was a negative predictor OR 0.16 (CI 95%: 0.09-0.30). The Logit model employing the selected variables was able to predict 76% of the cases for a <span style="color:black">cut value of 0.5.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">The ROC curve </span>analysis with an AUC of 0.8 allowed to select the best cut-off value of <span style="color:black">final </span>NT-pro-BNP of 576 pg/mL to predict LVEF &lt;40% (S 72.4%, E 72%) (Figure 1).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#201f1e">Kaplan-Meier analysis showed that HFrecEF pts had better survival compared to </span><span style="background-color:white"><span style="color:#212121">HFrEF pts (Log-rank test p=0.001) (Figure 2).</span></span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusions</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: The probability of recovery of LVEF is higher in patients without ischemic etiology, who tolerate target doses of ACEI/ARAII and with lower follow-up levels of NT-pro-BNP. The improvement of LVEF to at least 40% translates to better survival (65% vs 25% at 11 years).</span></span></p>