Prognostic Implications of Left Ventricular Ejection Fraction Improvement in Patients with Heart Failure with Reduced and Mildly Reduced Ejection Fraction.
Journal
Acta Cardiologica Sinica
Journal Volume
42
Journal Issue
1
Pages
62 - 73
ISSN
1011-6842
Date Issued
2026-01
Author(s)
Chen, Yi-Sheng
Huang, Chi-Cheng
Wang, Chun-Chieh
Chang, Hung-Yu
Hou, Charles Jia-Yin
Chao, Ting-Hsing
Hung, Chung-Lieh
Hsia, Chih-Ping
Tzeng, Bing-Hsiean
Wu, Yen-Wen
Abstract
Objectives: This study aimed to evaluate the prognostic implications and optimal timing for assessing left ventricular ejection fraction (LVEF) trajectory in patients with heart failure (HF) and an LVEF < 50%. Methods: The Taiwan Society of Cardiology HF Registry 2020 is a prospective, multicenter registry of hospitalized HF patients in Taiwan. This study included patients with an LVEF < 50% during their index HF hospitalization, and at least one follow-up echocardiogram within 2 years. HF with improved EF (HFimpEF) was defined as an absolute increase in LVEF > 10% from baseline. The primary endpoints were all-cause mortality and HF hospitalization at 2 years. Predictors of an improvement in LVEF trajectory were also evaluated. Results: A total of 1478 patients were enrolled, with 873 in the HFimpEF group and 605 in the non-HFimpEF group. HFimpEF was associated with a lower risk of mortality (hazard ratio: 0.41 [0.27-0.62], p < 0.001) and reduced HF hospitalizations (8.6% vs. 24.4%, p < 0.001) at 2 years follow-up. Subgroup analysis showed that survival benefits diverged at an LVEF improvement > 10%, emerging as early as 6 months and persisting beyond 12 months. Lower baseline LVEF was paradoxically associated with better survival. Neither maximal guideline-directed medical therapy (GDMT) score nor revascularization correlated with LVEF trajectory. However, HFimpEF patients received higher doses of renin-angiotensin system inhibitors and beta-blockers in the first year. Conclusion: LVEF trajectory at 6 months appears to be a valuable prognostic tool, and higher-dose fundamental HF therapy was more important than achieving a higher overall GDMT score. © 2026, Republic of China Society of Cardiology. All rights reserved.
Subjects
Guideline-directed medical therapy
Heart failure with improved ejection fraction
Prognosis
Real-world
Taiwan
Type
journal article