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Clinical Phenotypes and Prognosis of patients with heart failure with mildly reduced ejection fraction
Session:
Comunicações Orais - Sessão 01 - Insuficiência Cardíaca: a clínica primeiro
Speaker:
Vitor Hugo Pereira
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Vitor Hugo Pereira; Juliana Rodrigues; Rui Flores; Catia Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:NewsGotT"><span style="color:#000000"><strong><u><span style="color:black">Introduction</span></u></strong><strong><span style="color:black">:</span></strong> Heart failure (HF) is a complex clinical syndrome resulting from systolic and/or diastolic dysfunction, leading to considerable mortality and morbidity. T<span style="color:black"><span style="background-color:white">he recent definition of an intermediate clinical phenotype based on an ejection fraction (EF) between 41% and 49%, named HF with mildly reduced EF (HFmrEF), has fueled investigations into the clinical profile and prognosis of this patient group. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:NewsGotT"><span style="color:#000000"><strong><u><span style="color:black">Aims</span></u></strong><strong><span style="color:black">:</span></strong><span style="color:black"> T</span>he aim of this study was to characterize the clinical phenotype and explore the long term prognosis of patients with HFmrEF at 5-years of follow-up.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:NewsGotT"><span style="color:#000000"><strong><u><span style="color:black">Methods</span></u></strong><strong><span style="color:black">:</span></strong> This retrospective study included 279 outpatients with HFmrEF classified according to baseline LVEF (41-49%) between January and December 2016. Clinical, analytical and imagiological data were carefully collected and analyzed. In terms of prognosis, primary (overall mortality) and secondary endpoints (cardiovascular mortality, HF hospitalizations and major adverse cardiac events) were evaluated during a period of 5 years of follow-up. Patients were further classified as HFmrEF-Decreased if LVEF had decreased to <span style="color:#202124"><span style="background-color:white">≤</span></span> 40%, HFmrEF-Improved if LVEF had increased to ≥50%, or HFmrEF-Stable if they stayed in the same HF category. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:NewsGotT"><span style="color:#000000"><strong><u><span style="color:black">Results</span></u></strong><strong><span style="color:black">:</span></strong> Most of the clinical characteristics of HFmrEF patients were intermediate between HFrEF (HF with reduced EF) and HFpEF (HF with preserved EF) when compared with previous studies. However, HFmrEF shared with HFrEF several aspects, including male gender (73.8%), ischemic etiology (51.3<span style="color:black">%), and the lower prevalence of atrial fibrillation and non-cardiac comorbidities. </span>During a period of 5 years of follow-up, the overall cumulative survival was 68.5%. Regarding the LVEF trajectory, <span style="color:black">in a multivariate analysis including gender and age, patients in the group HFmrEF-Improved had lower mortality </span>at 5 years<span style="color:black"> when compared to HFmrEF-Decreased </span>[p =.004, HR (95%CI): 0.34(0.16–0.71)]. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:NewsGotT"><span style="color:#000000"><strong><u><span style="color:black">Conclusions</span></u></strong><strong><span style="color:black">:</span></strong> These findings strongly support that HFmrEF constitutes a distinct HF category with distinguished prognosis. LVEF trajectory provide meaningful information and may <span style="color:black">help clinicians to decide which patients should have more aggressive monitoring and medical therapy. </span></span></span></span></p> <p style="text-align:justify"> </p>
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