Dynamic Trajectories of Left Ventricular Ejection Fraction in Heart Failure
Por:
Lupon, J, Gavidia-Bovadilla, G, Ferrer, E, de Antonio, M, Perera-Lluna, A, Lopez-Ayerbe, J, Domingo, M, Nunez, J, Zamora, E, Moliner, P, Diaz-Ruata, P, Santesmases, J and Bayes-Genis, A
Publicada:
7 ago 2018
Categoría:
Cardiology and cardiovascular medicine
Resumen:
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 tong-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 tower 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. (C) 2018 by the American College of Cardiology Foundation.
Filiaciones:
:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Cardiovasc, Madrid, Spain
Gavidia-Bovadilla, G:
Technol Ctr Catalonia, Dept E Hlth, Eurecat, Barcelona, Spain
Univ Politecn Cataluna, Dept Engn Sistemes Automat & Informat Ind, Barcelona, Spain
Ferrer, E:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
Perera-Lluna, A:
Univ Politecn Cataluna, Dept Engn Sistemes Automat & Informat Ind, Barcelona, Spain
Networking Biomed Res Ctr Bioengn Biomat & Nanome, Madrid, Spain
Hosp St Joan de Deu, Inst Recerca Pediat, Barcelona, Spain
Lopez-Ayerbe, J:
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Barcelona, Spain
Nunez, J:
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Cardiovasc, Madrid, Spain
Hosp Clin Univ, INCLIVA, Cardiol Dept, Valencia, Spain
Univ Valencia, Dept Med, Valencia, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Cardiovasc, Madrid, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
Diaz-Ruata, P:
Univ Politecn Cataluna, Dept Engn Sistemes Automat & Informat Ind, Barcelona, Spain
Networking Biomed Res Ctr Bioengn Biomat & Nanome, Madrid, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Barcelona, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Barcelona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red CIBER Cardiovasc, Madrid, Spain
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