Left ventricular remodelling and prognosis after discharge in new‐onset acute heart failure with reduced ejection fraction

• Published in: ESC Heart Failure Vol. 8; no. 4; pp. 2679 - 2689
• Main Authors: Berge, Jan C., Vroegindewey, Maxime M., Veenis, Jesse F., Brugts, Jasper J., Caliskan, Kadir, Manintveld, Olivier C., Akkerhuis, K. Martijn, Boersma, Eric, Deckers, Jaap W., Constantinescu, Alina A.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-08-2021; John Wiley and Sons Inc; Wiley
• Subjects: Blood pressure; Body mass index; Cardiomyopathy; Cardiovascular disease; Coronary vessels; Data collection; Ejection fraction; Etiology; Heart failure; HFrEF; LV remodelling; Medical prognosis; Mortality; Myocarditis; Optimal medical treatment; Original; Original s; Patients; Prognosis; Software; LV remodelling; Prognosis; HFrEF; Optimal medical treatment
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.13299

Aims
This study aimed to investigate the left ventricular (LV) remodelling and long‐term prognosis of patients with new‐onset acute heart failure (HF) with reduced ejection fraction who were pharmacologically managed and survived until hospital discharge. We compared patients with ischaemic and non‐ischaemic aetiology.
Methods and results
This cohort study consisted of 111 patients admitted with new‐onset acute HF in the period 2008–2016 [62% non‐ischaemic aetiology, 48% supported by inotropes, vasopressors, or short‐term mechanical circulatory devices, and left ventricular ejection fraction (LVEF) at discharge 28% (interquartile range 22–34)]. LV dimensions, LVEF, and mitral valve regurgitation were used as markers for LV remodelling during up to 3 years of follow‐up. Both patients with non‐ischaemic and ischaemic HF had significant improvement in LVEF (P < 0.001 and P = 0.004, respectively) with significant higher improvement in those with non‐ischaemic HF (17% vs. 6%, P < 0.001). Patients with non‐ischaemic HF had reduction in LV end‐diastolic and end‐systolic diameters (6 and 10 mm, both P < 0.001), but this was not found in those with ischaemic HF [+3 mm (P = 0.09) and +2 mm (P = 0.07), respectively]. During a median follow‐up of 4.6 years, 98 patients (88%) did not reach the composite endpoint of LV assist device implantation, heart transplantation, or all‐cause mortality, with no difference between with ischaemic and non‐ischaemic HF [hazard ratio 0.69 (95% confidence interval 0.19–2.45)].
Conclusions
Patients with new‐onset acute HF with reduced ejection fraction discharged on optimal medical treatment have a good prognosis. We observed a considerable LV remodelling with improvement in LV function and dimensions, starting already at 6 months in patients with non‐ischaemic HF but not in their ischaemic counterparts.