Heart Failure With Preserved Ejection Fraction Infrequently Evolves Toward a Reduced Phenotype in Long-Term Survivors: A Long-Term Prospective Longitudinal Study

Josep Lupón, Giovana Gavidia-Bovadilla, Elena Ferrer, Marta De Antonio, Alexandre Perera-Lluna, Jorge López-Ayerbe, Mar Domingo, Julio Núñez, Elisabet Zamora, Pedro Moliner, Evelyn Santiago-Vacas, Javier Santesmases, Antoni Bayés-Genis

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13 Citations (Scopus)

Abstract

© 2019 American Heart Association, Inc. Background: Long-term trajectories of left ventricular ejection fraction (LVEF) in heart failure (HF) patients with preserved EF (HFpEF) remain unclear. Our objective was to assess long-term longitudinal trajectories in consecutive HFpEF patients and the prognostic impact of LVEF dynamic changes over time. Methods and Results: Consecutive ambulatory HFpEF patients admitted to a multidisciplinary HF Unit were prospectively evaluated by 2-dimensional echocardiography at baseline and at 1, 3, 5, 7, 9, and 11 years of follow-up. Exclusion criteria were patients having a previous known LVEF <50%, patients undergoing only 1 echocardiogram study, and those with a diagnosis of dilated, noncompaction, alcoholic, or toxic cardiomyopathy. One hundred twenty-six patients (age, 71±13 years; 63% women) were included. The main pathogeneses were valvular disease (36%) and hypertension (28%). Atrial fibrillation was present in 67 patients (53%). The mean number of echocardiographies performed was 3±1.2 per patient. Locally weighted error sum of squares curves showed a smooth decrease of LVEF during the 11-year follow-up that was statistically significant in linear mixed-effects modeling (P=0.01). Ischemic patients showed a higher decrease than nonischemics. The great majority (88.9%) of patients remained in the HFpEF category during follow-up; 9.5% evolved toward HF with midrange LVEF, and only 1.6% dropped to HF with reduced LVEF. No significant relationship was found between LVEF dynamics in the immediate preceding period and mortality. Conclusions: LVEF remained ≥50% in the majority of patients with HFpEF for ≤11 years. Only 1.6% of patients evolved to HF with reduced LVEF. Dynamic LVEF changes were not associated with mortality.
Original languageEnglish
Article numbere005652
JournalCirculation: Heart Failure
Volume12
DOIs
Publication statusPublished - 1 Mar 2019

Keywords

  • ejection fraction
  • follow-up studies
  • heart failure
  • humans
  • ventricular function

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