Heart Failure With Improved Ejection Fraction: Prevalence, Predictors, and Guideline-Directed Medical Therapy

被引:5
作者
Oommen, Sheethal G. [1 ]
Man, Ruzhual K. [2 ]
Talluri, Keerthi [3 ]
Nizam, Maryam [4 ]
Kohir, Tejashwini [3 ]
Aviles, Martin A. [5 ]
Nino, Mariana [6 ]
Jaisankar, Lakshmi Gokulnath [7 ]
Jaura, Jashan [8 ]
Wannakuwatte, Randev A. [9 ]
Tom, Leo [10 ]
Abraham, Jeby [11 ]
Siddiqui, Humza F. [12 ]
机构
[1] Grigore T Popa Univ Med & Pharm, Psychiat, Iasi, Romania
[2] Lady Hardinge Med Coll & Hosp, Res, Mumbai, India
[3] Ganni Subba Lakshmi Med Coll, Dept Med, Rajahmundry, India
[4] Valaichennai Base Hosp, Emergency Dept, Valaichennai, Sri Lanka
[5] Amigos Corazon, Cardiol, Quito, Ecuador
[6] Univ Rosario, Med, Bogota, Colombia
[7] Fathima Inst Med Sci, Gen Med, Kadapa, India
[8] Max Super Special Hosp, Gen Practice, Bathinda, India
[9] Grodno State Med Univ, Surg, Grodno, BELARUS
[10] Kowdoor Sadananda Hegde Med Acad, Internal Med, Mangalore, Karnataka, India
[11] Yenepoya Med Coll, Gen Med, Mangalore, India
[12] Jinnah Sindh Med Univ, Internal Med, Karachi, Pakistan
关键词
guideline-directed medical therapy (gdmt); b-type natriuretic peptide (bnp); remodeling; outcomes; left ventricular ejection fraction (lvef); heart failure with reduced ejection fraction (hfref); heart failure with improved ejection fraction (hfimpef); CARDIAC RESYNCHRONIZATION THERAPY; DEFIBRILLATOR IMPLANTATION; CLINICAL-OUTCOMES; BETA-BLOCKADE; FOLLOW-UP; RECOVERY; CARDIOMYOPATHY; ASSOCIATION; PROGNOSIS; ENALAPRIL;
D O I
10.7759/cureus.61790
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Recently, a new category of heart failure with improved ejection fraction (HFimpEF) has emerged in the classification system. This is defined as the subgroup of patients with heart failure with reduced ejection fraction (HFrEF) whose left ventricular ejection fraction has recovered partially or completely, with no specific cut-off values established yet in the guidelines. In our review, we aim to provide an overview of prevalence, predictors, mechanism of remodeling, and management strategies regarding HFimpEF. These patients constitute a sizeable cohort among patients with reduced ejection fraction. Certain patient characteristics including younger age and female gender, absence of comorbid conditions, low levels of biomarkers, and non-ischemic etiology were identified as positive predictors. The heart undergoes significant maladaptive changes post failure leading to adverse remodeling influenced etiology and duration. Goal-directed medical therapy including beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs) have notably improved cardiac function by inducing reverse remodeling. Despite a more favorable prognosis compared to HFrEF, patients with improved ejection fraction (EF) still face clinical events and reduced quality of life, and remain at risk of adverse outcomes. Although the evidence is scarce, it is advisable to continue treatment modalities despite improvement in EF, including device therapies, to prevent relapse and clinical deterioration. It is imperative to conduct further research to understand the mechanism leading to EF amelioration and establish guidelines to identify and direct management strategies.
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页数:19
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