Dynamic Trajectories of Left Ventricular Ejection Fraction in Heart Failure

Josep Lupón, Giovana Gavidia-Bovadilla, Elena Ferrer, Marta de Antonio, Alexandre Perera-Lluna, Jorge López-Ayerbe, Mar Domingo, Julio Núñez, Elisabet Zamora, Pedro Moliner, Patricia Díaz-Ruata, Javier Santesmases, Antoni Bayés-Genís

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110 Citations (Scopus)


© 2018 American College of Cardiology Foundation Background: Long-term trajectories of left ventricular ejection fraction (LVEF) in heart failure (HF) are incompletely characterized. Objectives: This study sought to examine LVEF trajectories in HF with reduced LVEF (<40%) and mid-range LVEF (40% to 49%) and the prognostic impact of LVEF dynamic changes over 15-year follow-up. Methods: In this prospective, consecutive, observational registry of real-life HF outpatients, the authors performed 2-dimensional echocardiography at baseline and on a structured schedule after 1 year and then every 2 years up to 15 years. Results: The mean number of LVEF measurements in the 1,160 included patients was 3.6 ± 1.7. As a whole, Loess curves of long-term LVEF trajectories showed an inverted U shape with a marked rise in LVEF during the first year, maintained up to a decade, and a slow LVEF decline thereafter (p for trajectory <0.001). This pattern was more pronounced in HF of nonischemic origin and in women. Patients with new-onset HF (≤12 months) had a higher early increase in LVEF, whereas patients with ischemic HF showed a lower LVEF increase at 1 year; both groups had a relative plateau thereafter. Patients with HF with mid-range LVEF had less of an increase (3 ± 9%) than those with HF with reduced LVEF (9 ± 12%) during the first year (p < 0.001), but the groups overlapped after 15 years. Patients who died had lower final LVEF and worse LVEF dynamics in the immediately preceding period than survivors. Conclusions: LVEF trajectories vary in HF depending on a number of disease modifiers, but an inverted U-shaped pattern with lower LVEF at both ends of the distribution emerged. A declining LVEF in the preceding period was associated with higher mortality.
Original languageEnglish
Pages (from-to)591-601
JournalJournal of the American College of Cardiology
Issue number6
Publication statusPublished - 7 Aug 2018


  • ejection fraction
  • etiology
  • heart failure
  • long-term follow-up
  • ventricular function


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