Valor pronóstico de una reevaluación precoz de la fracción de eyección reducida en insuficiencia cardíaca aguda / Prognostic value of early reassessment of reduced ejection fraction in acute heart failure

Background and objectives An improvement in left ventricular ejection fraction (LVEF) in patients with heart failure (HF) is associated with a better prognosis. Identifying these subjects early after an episode of decompensation, the necessary threshold of LVEF improvement, and its predictive factors are of great interest. Patients and methods One hundred and ten patients hospitalized for HF were prospectively reassessed at an early outpatient visit (mean of 38 days). Results and conclusions In subjects with depressed LVEF (<50%), 50.7% presented an improvement in LVEF≥5% between the acute episode and the outpatient visit. This improvement in depressed LVEF was found to be useful for identifying patients with a good prognosis (readmission due to HF+cardiovascular mortality, p=0.022) but not in patients with preserved LVEF (≥50%). Patients with improved LVEF were significantly younger and had new-onset HF, a better global longitudinal strain (GLS), and better renal function. A multivariate logistic regression model found GLS, new-onset HF, and a lower LV mass index as predictors of LVEF improvement ≥5% (AUC 0.85) (AU)

Antecedentes y objetivo La mejoría en la fracción de eyección de ventrículo izquierdo (FEVI) en insuficiencia cardíaca (IC) se relaciona con un mejor pronóstico. Identificar estos sujetos precozmente tras una descompensación, el umbral necesario de mejoría de FEVI y sus factores predictores resultan de gran interés. Pacientes y métodos Se reevaluaron prospectivamente 110 pacientes hospitalizados por IC en una visita ambulatoria precoz (media 38 días). Resultados y conclusiones En sujetos con FEVI deprimida (<50%) un 50,7% presentaron una mejoría de FEVI≥5% entre el episodio agudo y la visita ambulatoria. Esta mejoría en FEVI deprimida resultó ser útil para identificar pacientes con buen pronóstico (reingreso por IC+mortalidad cardiovascular, p=0,022), pero no en FEVI preservada (≥50%). Los pacientes con FEVI mejorada presentaban significativamente menor edad, debut de IC, mejor strain longitudinal global (SLG) y función renal. Un modelo de regresión logística multivariante seleccionó al SLG, debut de IC y un menor tamaño ventricular izquierdo como predictores de mejoría de FEVI≥5% (AUC 0,85) (AU)

Prognostic value of early reassessment of reduced ejection fraction in acute heart failure.

BACKGROUND AND OBJECTIVES: An improvement in left ventricular ejection fraction (LVEF) in patients with heart failure (HF) is associated with a better prognosis. Identifying these subjects early after an episode of decompensation, the necessary threshold of LVEF improvement, and its predictive factors are of great interest. PATIENTS AND METHODS: One hundred and ten patients hospitalized for HF were prospectively reassessed at an early outpatient visit (mean of 38 days). RESULTS AND CONCLUSIONS: In subjects with depressed LVEF (<50%), 50.7% presented an improvement in LVEF≥5% between the acute episode and the outpatient visit. This improvement in depressed LVEF was found to be useful for identifying patients with a good prognosis (readmission due to HF+cardiovascular mortality, p=0.022) but not in patients with preserved LVEF (≥50%). Patients with improved LVEF were significantly younger and had new-onset HF, a better global longitudinal strain (GLS), and better renal function. A multivariate logistic regression model found GLS, new-onset HF, and a lower LV mass index as predictors of LVEF improvement ≥5% (AUC 0.85).