A Universal New Definition of Heart Failure With Improved Ejection Fraction for Patients With Coronary Artery Disease

Haozhang Huang; Jin Liu; Min Lei; Zhou Yang; Kunming Bao; Qiang Li; Wenguang Lai; Bo Wang; Yibo He; Shiqun Chen; Chun-Quan Ou; Maimaitiaili Abudukerimu; Yuying Hu; Ning Tan; Jiyan Chen; Yong Liu

doi:10.3389/fphys.2021.770650

A Universal New Definition of Heart Failure With Improved Ejection Fraction for Patients With Coronary Artery Disease

Front Physiol. 2021 Dec 3:12:770650. doi: 10.3389/fphys.2021.770650. eCollection 2021.

Authors

Haozhang Huang^{1

2}, Jin Liu¹, Min Lei³, Zhou Yang⁴, Kunming Bao⁵, Qiang Li¹, Wenguang Lai^{1

6}, Bo Wang¹, Yibo He¹, Shiqun Chen¹, Chun-Quan Ou⁴, Maimaitiaili Abudukerimu⁷, Yuying Hu⁷, Ning Tan^{1

2

8}, Jiyan Chen^{1

2

8}, Yong Liu^{1

2

8}

Affiliations

¹ Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of Ultrasound, Fuwai Yunnan Cardiovascular Hospital, Kunming, China.
⁴ State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China.
⁵ Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
⁶ School of Biology and Biological Engineering, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.
⁷ Department of Cardiology, First People's Hospital of Kashgar, Kashgar, China.
⁸ School of Medicine, Guangdong Provincial People's Hospital, South China University of Technology, Guangzhou, China.

Abstract

Aims: The aims of this study were to describe the characteristics and outcomes of the universal new definition of heart failure with improved ejection fraction (HFimpEF) and to identify predictors for HFimpEF among patients with coronary artery disease (CAD). Methods: CAD subjects with heart failure with reduced ejection fraction (HFrEF) (EF ≤ 40%) at baseline were enrolled from the real-world registry of the Cardiorenal ImprovemeNt study from January 2007 to December 2018. The new definition of HFimpEF was defined as left ventricular EF (LVEF) of≤40% at baseline and with improvement of up to 40% and at least a ≥ 10% increase during 1 month to 1 year after discharge. Results: Of the 747 CAD patients with HFrEF (86.7% males, mean age: 61.4 ± 11 years), 267 (35.7%) patients conformed to the new HFimpEF definition. Patients with HFimpEF were younger (adjusted odds ratio [aOR]: 0.98 [0.97-0.99]) and had a higher rate of hypertension (aOR:1.43 [1.04-1.98]), lower rate of percutaneous coronary intervention (PCI) treatment at the time of detection of HFrEF (aOR: 0.48 [0.34-0.69]), history of PCI (aOR: 0.51 [0.28-0.88]), history of acute myocardial infarction (aOR: 0.40 [0.21-0.70]), and lower left ventricular end diastolic diameter (aOR: 0.92 [0.90-0.95]). During 3.3-year follow-up, patients with HFimpEF demonstrated lower rates of long-term all-cause mortality (13.1% vs. 20.8%, aHR: 0.61[0.41-0.90]). Conclusion: In our study, CAD patients with HFimpEF achieved a better prognosis compared to those with persistent HFrEF. Patients with CAD meeting the criteria for the universal definition of HFimpEF tended to be younger, presented fewer clinical comorbidities, and had lower left ventricular end diastolic diameter.

Keywords: characteristic; coronary artery disease; heart failure; heart failure with improved ejection fraction; left ventricular ejection fraction; mortality.