Abstract：
OBJECTIVE: We investigated the prevalence, clinical characteristics, and prognosis of patients with heart failure (HF) with improved ejection fraction (HFimpEF).
RESULTS: We used data from BIOSTAT-CHF including patients with a left ventricular ejection fraction (LVEF) ≤40% at baseline who had LVEF re-assessed at 9 months. HFimpEF was defined as a LVEF >40% and a LVEF ≥10% increase from baseline at 9 months. We validated findings in the ASIAN-HF registry. The primary outcome was a composite of time to HF rehospitalization or all-cause mortality. In BIOSTAT-CHF, about 20% of patients developed HFimpEF, that was associated with a lower primary event rate of all-cause mortality (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.28-0.97, p = 0.040) and the composite endpoint (HR 0.46, 95% CI 0.30-0.70, p < 0.001) compared with patients who remained in persistent HF with reduced ejection fraction (HFrEF). The findings were similar in the ASIAN-HF (HR 0.40, 95% CI 0.18-0.89, p = 0.024, and HR 0.29, 95% CI 0.17-0.48, p < 0.001). Five independently common predictors for HFimpEF in both BIOSTAT-CHF and ASIAN-HF were female sex, absence of ischaemic heart disease, higher LVEF, smaller left ventricular end-diastolic and end-systolic diameter at baseline. A predictive model combining only five predictors (absence of ischaemic heart disease and left bundle branch block, smaller left ventricular end-systolic and left atrial diameter, and higher platelet count) for HFimpEF in the BIOSTAT-CHF achieved an area under the curve of 0.772 and 0.688 in the ASIAN-HF (due to missing left atrial diameter and platelet count).
CONCLUSIONS: Approximately 20-30% of patients with HFrEF improved to HFimpEF within 1 year with better clinical outcomes. In addition, the predictive model with clinical predictors could more accurately predict HFimpEF in patients with HFrEF.
RESULTS: We used data from BIOSTAT-CHF including patients with a left ventricular ejection fraction (LVEF) ≤40% at baseline who had LVEF re-assessed at 9 months. HFimpEF was defined as a LVEF >40% and a LVEF ≥10% increase from baseline at 9 months. We validated findings in the ASIAN-HF registry. The primary outcome was a composite of time to HF rehospitalization or all-cause mortality. In BIOSTAT-CHF, about 20% of patients developed HFimpEF, that was associated with a lower primary event rate of all-cause mortality (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.28-0.97, p = 0.040) and the composite endpoint (HR 0.46, 95% CI 0.30-0.70, p < 0.001) compared with patients who remained in persistent HF with reduced ejection fraction (HFrEF). The findings were similar in the ASIAN-HF (HR 0.40, 95% CI 0.18-0.89, p = 0.024, and HR 0.29, 95% CI 0.17-0.48, p < 0.001). Five independently common predictors for HFimpEF in both BIOSTAT-CHF and ASIAN-HF were female sex, absence of ischaemic heart disease, higher LVEF, smaller left ventricular end-diastolic and end-systolic diameter at baseline. A predictive model combining only five predictors (absence of ischaemic heart disease and left bundle branch block, smaller left ventricular end-systolic and left atrial diameter, and higher platelet count) for HFimpEF in the BIOSTAT-CHF achieved an area under the curve of 0.772 and 0.688 in the ASIAN-HF (due to missing left atrial diameter and platelet count).
CONCLUSIONS: Approximately 20-30% of patients with HFrEF improved to HFimpEF within 1 year with better clinical outcomes. In addition, the predictive model with clinical predictors could more accurately predict HFimpEF in patients with HFrEF.
摘要：
目的：我们调查了患病率，临床特征,射血分数（HFimpEF）改善的心力衰竭（HF）患者的预后。
结果：我们使用了来自BIOSTAT-CHF的数据，包括基线时左心室射血分数(LVEF)≤40%、在9个月时重新评估LVEF的患者。HFimpEF定义为在9个月时LVEF>40%且LVEF比基线增加≥10%。我们在ASIAN-HF注册中验证了研究结果。主要结局是HF再住院时间或全因死亡率的复合结果。在生物统计CHF中，大约20%的患者出现HFimpEF,与持续心力衰竭且射血分数(HFrEF)降低的患者相比,这与主要事件发生率较低的全因死亡率(风险比[HR]0.52,95%置信区间[CI]0.28~0.97,p=0.040)和复合终点(HR0.46,95%CI0.30~0.70,p<0.001)相关.ASIAN-HF的研究结果相似（HR0.40，95％CI0.18-0.89，p=0.024，HR0.29，95％CI0.17-0.48，p<0.001）。在BIOSTAT-CHF和ASIAN-HF中，HFimpEF的五个独立的常见预测因子是女性，没有缺血性心脏病，更高的LVEF，基线时左心室舒张末期和收缩末期直径较小。仅结合五个预测因子的预测模型（没有缺血性心脏病和左束支传导阻滞，左心室收缩末期和左心房直径较小，BIOSTAT-CHF中HFimpEF的血小板计数较高）在ASIAN-HF中的曲线下面积为0.772和0.688（由于左心房直径和血小板计数缺失）。
结论：大约20-30%的HFrEF患者在1年内改善到HFimpEF，具有更好的临床结局。此外,具有临床预测因子的预测模型可以更准确地预测HFrEF患者的HFimpEF.
结果：我们使用了来自BIOSTAT-CHF的数据，包括基线时左心室射血分数(LVEF)≤40%、在9个月时重新评估LVEF的患者。HFimpEF定义为在9个月时LVEF>40%且LVEF比基线增加≥10%。我们在ASIAN-HF注册中验证了研究结果。主要结局是HF再住院时间或全因死亡率的复合结果。在生物统计CHF中，大约20%的患者出现HFimpEF,与持续心力衰竭且射血分数(HFrEF)降低的患者相比,这与主要事件发生率较低的全因死亡率(风险比[HR]0.52,95%置信区间[CI]0.28~0.97,p=0.040)和复合终点(HR0.46,95%CI0.30~0.70,p<0.001)相关.ASIAN-HF的研究结果相似（HR0.40，95％CI0.18-0.89，p=0.024，HR0.29，95％CI0.17-0.48，p<0.001）。在BIOSTAT-CHF和ASIAN-HF中，HFimpEF的五个独立的常见预测因子是女性，没有缺血性心脏病，更高的LVEF，基线时左心室舒张末期和收缩末期直径较小。仅结合五个预测因子的预测模型（没有缺血性心脏病和左束支传导阻滞，左心室收缩末期和左心房直径较小，BIOSTAT-CHF中HFimpEF的血小板计数较高）在ASIAN-HF中的曲线下面积为0.772和0.688（由于左心房直径和血小板计数缺失）。
结论：大约20-30%的HFrEF患者在1年内改善到HFimpEF，具有更好的临床结局。此外,具有临床预测因子的预测模型可以更准确地预测HFrEF患者的HFimpEF.
