Rate of Recovery of Left Ventricular Ejection Fraction in a Real-World Population of Patients Receiving a Wearable Cardioverter Defibrillator

Background

This study aimed to investigate the rate of early improvement in ejection fraction (EF) within 21 - 60 days among patients with cardiomyopathy who were provided with a wearable cardioverter defibrillator (WCD).

Methods

This was a retrospective study of patients who received a WCD at our institution to determine the rate of improvement in left ventricular EF (LVEF) to ≥ 35-40%. Among 990 patients who received a WCD during the study period, 101 had an echocardiogram performed during the subsequent 21 - 60 days. Patients were stratified according to their initial EF, as well as age, gender, number of heart failure medications, and ischemic vs. nonischemic cardiomyopathy. Multivariate logistic regression analysis was performed to assess the influence of these variables on the subsequent improvement in EF.

Results

There were 39 patients who had improvement in their EF to ≥ 35-40%. The only significant predictor of EF recovery was the initial EF. There was a direct correlation between initial EF category and the likelihood of improvement in EF. For every unit increase in initial EF category, the odds of improvement increased 1.73 times (95% confidence interval (CI): 1.22 - 2.45). Age (P = 0.20), gender (P = 0.10), ischemic cardiomyopathy (P = 0.40), and number of heart failure medications at the time of WCD placement (P = 0.26) were not significant predictors of improved LVEF.

Conclusions

This study showed a rate of improvement in EF to ≥ 35-40% of 39% within 21 - 60 days of placement of a WCD among patients with both ischemic and nonischemic cardiomyopathy. The only significant clinical predictor of EF improvement was initial EF.

Left ventricular function recovery after ST-elevation myocardial infarction: correlates and outcomes

BACKGROUND

Contemporary data on left ventricular function (LVF) recovery in patients with left ventricular dysfunction after ST-elevation myocardial infarction (STEMI) are scarce and to date, no comparison has been made with patients with a baseline normal LVF. This study examined predictors of LVF recovery and its relation to outcomes in STEMI.

METHODS

Patients presenting with STEMI between January 2010 and December 2016 were categorized in three groups after 3 months according to left ventricular ejection fraction (EF): (i) baseline normal LVF (EF ≥ 50% at baseline); (ii) recovered LVF (EF < 50% at baseline and ≥ 50% after 3 months); and (iii) reduced LVF (EF < 50% at baseline and after 3 months). Heart failure hospitalization, all-cause mortality and cardiovascular mortality were compared between the three groups.

RESULTS

Of 577 patients, 341 (59%) patients had a baseline normal LVF, 112 (19%) had a recovered LVF and 124 (22%) had a reduced LVF. Independent correlates of LVF recovery were higher baseline EF, lower peak troponin and cardiac arrest. After median 5.8 years, there was no difference in outcomes between patients with LVF recovery and baseline normal LVF. In contrast, even after multivariate adjustment, patients with persistently reduced LVF had a higher risk for heart failure hospitalization (HR 5.00; 95% CI 2.17-11.46) and all-cause mortality (HR 1.87; 95% CI 1.11-3.16).

CONCLUSION

In contemporary treated STEMI patients, prognosis is significantly worse in those with a persistently reduced LVF after 3 months, compared with patients with a baseline normal LVF and those with LVF recovery.

Systolic function recovery in Heart Failure: Frequency, prognostic impact and predictors

BACKGROUND

Systolic function recovery in patients with Heart failure (HF) with reduced ejection fraction (EF) is well recognized but not completely understood. We aimed to characterize HF patients with systolic function recovery, its prognostic impact and predictors.

METHODS

We analysed patients followed in a HF clinic (2006-2015) with 2 echocardiograms performed. Partial recovery: EF recovery without attaining EF ≥ 50%; total recovery: patients reached EF ≥ 50%. Median follow-up from first echocardiogram: 69 months. Multivariate logistic regression models to determine recovery predictors.

RESULTS

We analysed 304 patients with at least mild left ventricular dysfunction. During a median 34 months between echocardiogram re-evaluation 150 (49.3%) patients showed no EF recovery; 55 (18.1%) had partial recovery and 99 (32.6%) totally recovered. Mean patients age: 66; 71.1% men, high comorbidity burden; ischemic HF: 35.5%. Non-recovered patients were mostly men (80.7% vs 61.8% in partially; 61.6% in fully-recovered) with ischemic HF (46.0% vs 32.5% in partially; 21.2% in fully-recovered). Comorbidity burden, NYHA class and therapy were similar. During follow-up, 156 patients (46.7%) died. Patients with total recovery had a multivariate-adjusted 54% lower risk of dying when compared to non-recovered. Partially-recovered patients showed a non-significant adjusted 8% mortality reduction. Independent predictors of systolic function recovery were female gender(OR: 2.17, 95% CI 1.11-4.35), non-ischemic aetiology (OR: 2.78, 95% CI 1.35-5.56), and end diastolic left ventricular diameter < 60 mm (OR: 3.12, 95% CI 1.56-6.25).

CONCLUSIONS

HF-recovered patients were mainly women with non-ischemic HF and smaller left ventricles. These patients had significantly better prognosis than those with persistently reduced EF.