Management of Heart Failure With Improved Ejection Fraction

JACC Heart Failure, Journal Year: 2025, Volume and Issue: 13(4), P. 537 - 553

Published: April 1, 2025

Heart failure with improved ejection fraction (HFimpEF) is defined by left ventricular (LVEF) among patients who previously had reduced LVEF. HFimpEF associated prognosis, albeit persistent risk of relapse and adverse events in some patients. Current guidelines thus recommend sustained indefinite guideline-directed medical therapy (GDMT) for all HFimpEF. Emerging clinical experience suggests that heart arising from acute etiologies fully resolve along complete LVEF recovery may have a favorable prognosis lower relapse. Indeed, cohort case series studies demonstrated the feasibility safe de-escalation GDMT select specific etiologies, multiple small trials ongoing. Future should investigate whether advanced imaging or blood biomarkers could aid stratifying recovered LVEF, partial be feasible, implantable cardioverter-defibrillator can safely discontinued.

Language: Английский

Development and validation of an integrated prognostic model for all-cause mortality in heart failure: a comprehensive analysis combining clinical, electrocardiographic, and echocardiographic parameters

BMC Cardiovascular Disorders, Journal Year: 2025, Volume and Issue: 25(1)

Published: March 26, 2025

Accurate risk prediction in heart failure remains challenging due to its complex pathophysiology. We aimed develop and validate a comprehensive prognostic model integrating demographic, electrocardiographic, echocardiographic, biochemical parameters. conducted retrospective cohort study of 445 patients. The was randomly divided into training (n = 312) validation 133) sets. Feature selection performed using LASSO regression followed by backward stepwise Cox regression. A nomogram constructed based on independent predictors. Model performance assessed through discrimination, calibration, decision curve analyses. Random survival forest analysis variable importance. During median follow-up 4.14 years, 142 deaths (31.91%) occurred. Our development systematic approach: initial feature identified 15 potential predictors, which were further refined nine predictors final included age, NYHA class, left ventricular systolic dysfunction, atrial septal defect, aortic valve annulus calcification, tricuspid regurgitation severity, QRS duration, T wave offset, NT-proBNP. integrated demonstrated good discrimination for 2-, 3-, 5-year mortality both (AUCs: 0.726, 0.755, 0.809) cohorts 0.686, 0.678, 0.706). Calibration plots analyses confirmed the model's reliability clinical utility across different time horizons. individualized prediction. Kaplan-Meier individual revealed significant stratification outcomes, while restricted cubic spline non-linear relationships between continuous variables risk. top five (age, NT-proBNP, NYHA), compared with our nine-variable model, confirming superior all points. showed robust predicting all-cause ability provide estimates may facilitate decision-making patient stratification. Not applicable.

Language: Английский

Incidence, progression, and outcomes of heart failure with improved ejection fraction: The added value of longitudinally assessed ejection fraction

International Journal of Cardiology, Journal Year: 2024, Volume and Issue: unknown, P. 132759 - 132759

Published: Nov. 1, 2024

Language: Английский