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Vol. 223. Issue 2.
Pages 90-95 (February 2023)
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Vol. 223. Issue 2.
Pages 90-95 (February 2023)
Brief Original
Prognostic value of early reassessment of reduced ejection fraction in acute heart failure
Valor pronóstico de una reevaluación precoz de la fracción de eyección reducida en insuficiencia cardíaca aguda
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J.M. Salvador-Casabóna,
Corresponding author
juanma_cheick@hotmail.com

Corresponding author.
, D. Grados-Sasoa,b, I. Lacambra-Blascoa, I. Giménez-Lópezc, J.I. Pérez-Calvoc,d
a Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Sección de Cardiología, Hospital de Barbastro, Barbastro, Huesca, Spain
c Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
d Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Table 1. Clinical, echocardiographic, and lab testing characteristics of patients with reduced ejection fraction (<50%) according to LVEF variation greater or lesser than 5%. The results corresponding to the means of the differences in the values between studies are also shown. For the qualitative variables, the percent (%) of cases of each group together with the number of individuals in parentheses, the difference of proportions and the value (p) of the difference of proportions test are shown; for the quantitative variables, the mean values ±standard error or the medians and interquartile range (IQ), the difference between values and the value (p) of the t test of differences between values are shown.
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Abstract
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 LVEF5% 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).

Keywords:
Heart failure
Depressed LVEF
Recovered LVEF
Global longitudinal strain
Resumen
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 FEVI5% 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 FEVI5% (AUC 0,85).

Palabras clave:
Insuficiencia cardíaca
FEVI deprimida
FEVI recuperada
Strain longitudinal global

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