SPC365

Heart failure with mildly reduced ejection fraction is not all alike: the importance of disease trajectory

Session: Posters (Sessão 3 - Écran 5) - Insuficiência Cardíaca - Clínica
Speaker: Joana Silva 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: Joana Silva Ferreira; Rui Antunes Coelho; Jéni Quintal; Ana Fátima Esteves; Sara Gonçalves; Tatiana Duarte; Cátia Costa; Rui Caria
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">Background</span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">: Heart failure&nbsp;with mildly reduced ejection fraction (HFmrEF)&nbsp;is a relatively recent category whose prognosis is described in the literature as intermediate between preserved&nbsp;and reduced&nbsp;ejection fraction (EF). However, this group of&nbsp;patients can be quite heterogeneous, particularly in what concerns their place in HF disease trajectory, since it&nbsp;includes both patients with newly-diagnosed HFmrEF and those&nbsp;who improve from reduced EF to mildly reduced EF.</span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">Purpose</span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">: To compare the phenotype and prognosis of patients with mildly reduced EF at diagnosis with those who initially had reduced EF, which later improved to mildly reduced.</span></span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif"><strong>Methods</strong>: We conducted a retrospective study including all consecutive patients assessed in our HF clinic between 2018 and 2020 who had mildly reduced EF [41-49%]. Participants were divided into two groups: HFmrEF if EF was consistently between 41-49% and imp-HFmrEF if EF had previously been &lt;40%.&nbsp;</span></span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">We compared HF etiology, comorbidities, ECG patterns, blood markers and echocardiogram results between the two groups. The primary endpoint was a composite of death and hospitalizations for HF or ventricular arrhythmias. </span></span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif"><strong>Results</strong>: We included 102 patients with a median age of 68 years observed in our HF clinic between 2018 and 2020. The sample was well balanced between HFmrEF (51%) and imp-HFmrEF (49%). Baseline characteristics and comorbidities were similar between the groups, except for&nbsp;a more frequent history of myocardial infarction among HFmrEF patients (45% vs 24%, p=0.026). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">For both groups, the most common HF etiology was ischemic heart disease, although tendentially more dominant for HFmrEF patients compared with imp-HFmrEF (56% vs 37%, p=0.055). On the contrary, a toxic etiology was more frequent among imp-HFmrEF patients (16% vs 2%, p=0.015). Left ventricular volumes did not differ between the groups, nor did NT-proBNP values. However, as expected, patients with imp-HFmrEF were under more neurohormonal medication compared with HFmrEF.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">At a median follow-up of 2.3 years, imp-HFmrEF was associated with lower rates of death or hospitalization for HF or ventricular arrhythmias (14% vs 31%;&nbsp;log-rank test: p=0.037), with a hazard ratio of 0.403 (95% CI 0.166-0.980).&nbsp; Additionally, there was also a tendency towards higher rates of worsening EF to &lt; 40% among HFmrEF patients (16% vs 6%, not reaching statistical significance). </span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">Conclusions</span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Arial Unicode MS&quot;,sans-serif">: This study confirms that among HF patients with mildly reduced EF, different phenotypes with differing disease trajectories coexist. It also suggests that clinical prognosis (and, probably, the risk of EF deterioration) of patients diagnosed with HFmrEF is worse, compared with those who improve from reduced EF to mildly reduced EF. Further research with larger samples is required to identify predictors of EF deterioration and assess the potential role of intensification of neurohormonal modulation in preventing it.</span></span></span></span></span></p>