Clin Res Cardiol 100, Suppl 1, April 2011

P403 - Is prediction of improvement in left ventricular ejection fraction after a hospitalization for decompensated systolic heart failure possible?
S. Brenner1, G. Güder1, D. Berliner1, C. Morbach1, R. Jahns1, S. Störk1, G. Ertl1, C. E. Angermann1
1Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg;
Background and aims: After a hospitalization for cardiac decompensation changes of left ventricular ejection fraction (LVEF) correlate with long term outcome in patients with systolic heart failure. In the present study, we aimed to identify predictors of significant LVEF improvement at a follow-up examination six months after discharge.
Methods: Patients with systolic heart failure hospitalized for cardiac decompensation were eligible if their LVEF was still  ≤40% after best possible recompensation prior to discharge. Evaluation at the time of discharge and after six months included medical history, clinical examination, heart failure, blood chemistry, electrocardiogram and echocardiography. LVEF was quantified using Simpson biplane method; an increase of >8.5% was considered a significant improvement, and a decrease of >8.5% a significant deterioration.
Results: 654 patients participated. Mean age was 66±12 years, and 75% were male. After six months LVEF had improved in 59% (386/654).  In 36% (238/654) LVEF was unchanged (±8.5%). In 5% (30/654) LVEF had decreased by >8.5%. Improvement of LVEF was associated with younger age (65±13 vs 67±11 years, p=0.013), female sex (29 vs. 20%, p=0.008), recent onset heart failure (p=0.001), a decrease in heart rate during follow-up (median -12 vs -5 bpm, p<0.001) and initial absence of left bundle branch block (74 vs. 61% p=0.001). Lower initial LVEF (29±8 vs. 33±8%, p<0.001) and lower initial left ventricular enddiastolic diameter (61±8 vs 63±10mm, p=0.007) also correlated with LVEF improvement. Conversely, renal dysfunction (glomerular filtration rate <60ml/min/1.73 m²) and ischaemic heart failure aetiology were associated with unchanged or decreased LVEF (56 vs. 40%, p<0.001, and 42 vs 33%, p=0.026, respectively), Cardiac interventions or surgery performed during follow-up period in 8% of the patients were not associated with LVEF improvement.
Conclusion: Most patients who survive the first six months after a hospitalization for systolic heart failure experience significant LVEF improvement. Recent onset heart failure, non-ischaemic aetiology and absence of left bundle branch block render improvement more likely, while renal dysfunction and ischaemic heart failure aetiology are risk factors for future LVEF deterioration and make closer follow-up advisable. Heart rate reduction correlates with improvement of LVEF.
Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y