Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction
Abstract Background Patients with heart failure with reduced ejection fraction (HFrEF) who achieve reverse remodelling (RR) can experience a new decrease in ejection fraction (EF), and the predictors of sustained RR (SRR) are not completely understood. Objectives The study aims to identify predictor...
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Wiley
2025-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15241 |
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| author | Silas Ramos Furquim Edimar Alcides Bocchi Maria Tereza Sampaio de Sousa Lira Mauro Rogerio de Barros Wanderley Jr Daniel Catto deMarchi Pamela Camara Maciel Andre Zimerman Felix Jose Alvarez Ramires Luciano Nastari Bruno Biselli Paulo Roberto Chizzola Robinson Tadeu Munhoz Fábio Fernandes Silvia Moreira Ayub‐Ferreira |
| author_facet | Silas Ramos Furquim Edimar Alcides Bocchi Maria Tereza Sampaio de Sousa Lira Mauro Rogerio de Barros Wanderley Jr Daniel Catto deMarchi Pamela Camara Maciel Andre Zimerman Felix Jose Alvarez Ramires Luciano Nastari Bruno Biselli Paulo Roberto Chizzola Robinson Tadeu Munhoz Fábio Fernandes Silvia Moreira Ayub‐Ferreira |
| author_sort | Silas Ramos Furquim |
| collection | DOAJ |
| description | Abstract Background Patients with heart failure with reduced ejection fraction (HFrEF) who achieve reverse remodelling (RR) can experience a new decrease in ejection fraction (EF), and the predictors of sustained RR (SRR) are not completely understood. Objectives The study aims to identify predictors of SRR in patients with HFrEF after an increase in EF and evaluate SRR prognosis. Methods In this retrospective, observational study, we evaluated a real‐life cohort of patients with HFrEF and ≥2 consecutive echocardiograms, divided according to left ventricular EF (LVEF) trajectory: no RR (NRR: 3/3 LVEF measurements < 40%), non‐SRR (NSRR: second LVEF ≥ 40%, third LVEF < 40%), and SRR (SRR: second and third LVEF ≥ 40%). Results We included 3628 of 8072 assessed HF patients in the analysis, with mean age 56.2 (±13.4) years, 64.4% male and 77.7% New York Heart Association (NYHA) I–II. Improved EF was observed for 1342 (37%) patients. Among those who achieved RR, 310 (23%) were NSRR, and 1032 (77%) were SRR. The mean (±SE) survival after the second echocardiogram was 10.6 (±0.2) years. The SRR group had the longest survival (12.2 ± 0.3 years), followed by the NSRR (10.6 ± 0.5) and NRR (9.8 ± 0.2 years) groups (P < 0.001). According to logistic multivariable regression, second LVEF [odds ratio (OR) = 1.06, confidence interval (CI) = 1.03–1.90, P < 0.001], second left ventricular end‐systolic diameter (LVESD) (OR = 0.93, CI = 0.90–0.96, P < 0.001), second IV septum thickness (OR = 1.12, CI = 1.03–1.23, P = 0.012), systolic blood pressure (OR = 1.01, CI = 1.00–1.02, P = 0.014), NYHA I–II (OR = 1.86, CI = 1.27–2.74, P = 0.001) and furosemide non‐use (OR = 1.87, CI = 1.27–2.74, P < 0.001) independently predicted SRR. Conclusions Patients with greater EF increases and LVESD reductions at EF recovery, greater septum thickness, higher blood pressure, no need for diuretics and NYHA I/II maintenance had the best chance of maintaining recovered ventricular function. |
| format | Article |
| id | doaj-art-a3b6f75f37c240d2b322e5e3cb25f736 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
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| series | ESC Heart Failure |
| spelling | doaj-art-a3b6f75f37c240d2b322e5e3cb25f7362025-08-20T03:53:16ZengWileyESC Heart Failure2055-58222025-06-011232190219910.1002/ehf2.15241Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fractionSilas Ramos Furquim0Edimar Alcides Bocchi1Maria Tereza Sampaio de Sousa Lira2Mauro Rogerio de Barros Wanderley Jr3Daniel Catto deMarchi4Pamela Camara Maciel5Andre Zimerman6Felix Jose Alvarez Ramires7Luciano Nastari8Bruno Biselli9Paulo Roberto Chizzola10Robinson Tadeu Munhoz11Fábio Fernandes12Silvia Moreira Ayub‐Ferreira13Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilBeth Israel Deaconess Medical Center/Harvard Medical School, Boston, EUA Boston Massachusetts USAInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilClinical Trials Unit Hospital Moinhos de Vento, Moinhos de Vento College of Health Sciences Porto Alegre BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilInstituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo São Paulo SP BrazilAbstract Background Patients with heart failure with reduced ejection fraction (HFrEF) who achieve reverse remodelling (RR) can experience a new decrease in ejection fraction (EF), and the predictors of sustained RR (SRR) are not completely understood. Objectives The study aims to identify predictors of SRR in patients with HFrEF after an increase in EF and evaluate SRR prognosis. Methods In this retrospective, observational study, we evaluated a real‐life cohort of patients with HFrEF and ≥2 consecutive echocardiograms, divided according to left ventricular EF (LVEF) trajectory: no RR (NRR: 3/3 LVEF measurements < 40%), non‐SRR (NSRR: second LVEF ≥ 40%, third LVEF < 40%), and SRR (SRR: second and third LVEF ≥ 40%). Results We included 3628 of 8072 assessed HF patients in the analysis, with mean age 56.2 (±13.4) years, 64.4% male and 77.7% New York Heart Association (NYHA) I–II. Improved EF was observed for 1342 (37%) patients. Among those who achieved RR, 310 (23%) were NSRR, and 1032 (77%) were SRR. The mean (±SE) survival after the second echocardiogram was 10.6 (±0.2) years. The SRR group had the longest survival (12.2 ± 0.3 years), followed by the NSRR (10.6 ± 0.5) and NRR (9.8 ± 0.2 years) groups (P < 0.001). According to logistic multivariable regression, second LVEF [odds ratio (OR) = 1.06, confidence interval (CI) = 1.03–1.90, P < 0.001], second left ventricular end‐systolic diameter (LVESD) (OR = 0.93, CI = 0.90–0.96, P < 0.001), second IV septum thickness (OR = 1.12, CI = 1.03–1.23, P = 0.012), systolic blood pressure (OR = 1.01, CI = 1.00–1.02, P = 0.014), NYHA I–II (OR = 1.86, CI = 1.27–2.74, P = 0.001) and furosemide non‐use (OR = 1.87, CI = 1.27–2.74, P < 0.001) independently predicted SRR. Conclusions Patients with greater EF increases and LVESD reductions at EF recovery, greater septum thickness, higher blood pressure, no need for diuretics and NYHA I/II maintenance had the best chance of maintaining recovered ventricular function.https://doi.org/10.1002/ehf2.15241heart failure with reduced ejection fractionreverse remodellingsustained reverse remodelling |
| spellingShingle | Silas Ramos Furquim Edimar Alcides Bocchi Maria Tereza Sampaio de Sousa Lira Mauro Rogerio de Barros Wanderley Jr Daniel Catto deMarchi Pamela Camara Maciel Andre Zimerman Felix Jose Alvarez Ramires Luciano Nastari Bruno Biselli Paulo Roberto Chizzola Robinson Tadeu Munhoz Fábio Fernandes Silvia Moreira Ayub‐Ferreira Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction ESC Heart Failure heart failure with reduced ejection fraction reverse remodelling sustained reverse remodelling |
| title | Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction |
| title_full | Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction |
| title_fullStr | Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction |
| title_full_unstemmed | Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction |
| title_short | Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction |
| title_sort | predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction |
| topic | heart failure with reduced ejection fraction reverse remodelling sustained reverse remodelling |
| url | https://doi.org/10.1002/ehf2.15241 |
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