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Original Article

Heart Failure with Recovered Ejection Fraction: Clinical Description, Biomarkers, and Outcomes

Anupam Basuray, Benjamin French, Bonnie Ky, Esther Vorovich, Caroline Olt, Nancy K. Sweitzer, Thomas P. Cappola, James C. Fang
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https://doi.org/10.1161/CIRCULATIONAHA.113.006855
Circulation. 2014;CIRCULATIONAHA.113.006855
Originally published May 5, 2014
Anupam Basuray
University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH
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  • For correspondence: anupambasuray@gmail.com
Benjamin French
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Bonnie Ky
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Esther Vorovich
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Caroline Olt
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Nancy K. Sweitzer
University of Arizona, Tucson, AZ
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Thomas P. Cappola
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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James C. Fang
University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH; University of Utah, Salt Lake City, UT
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Abstract

Background—We hypothesized that heart failure (HF) patients who recover left ventricular function (HF-Recovered) have a distinct clinical phenotype, biology and prognosis compared to HF with reduced ejection fraction (HF-REF) and HF with preserved ejection fraction (HF-PEF).

Methods and Results—The Penn Heart Failure Study (PHFS) is a prospective cohort of 1,821 chronic HF patients recruited from tertiary HF clinics. Participants were divided into three categories based on echocardiograms: HF-REF if EF<50%, HF-PEF if EF consistently ≥50%, and HF-Recovered if EF on enrollment to PHFS was ≥50% but prior EF<50%. A significant portion of HF-Recovered patients had an abnormal biomarker profile at baseline, including 44% with detectable Troponin I, although in comparison, median levels of BNP, sFlt-1, Troponin I and creatinine were greater in HF-REF and HF-PEF patients. In unadjusted Cox models over a maximum follow-up of 8.9 years, the hazard ratio (HR) for death, transplant or ventricular assist device in HF-REF was 4.1 (95%CI 2.4-6.8; p<0.001) and in HF-PEF was 2.3 (95%CI 1.2-4.5; p=0.013), as compared to HF-Recovered. The unadjusted HR for cardiac hospitalization in HF-REF was 2.0 (95%CI 1.5-2.7; p<0.001) and in HF-PEF was 1.3 (95%CI 0.90-2.0; p=0.15), compared to HF-Recovered. Results were similar in adjusted models.

Conclusions—HF-Recovered is associated with a better biomarker profile and event-free survival than HF-REF and HF-PEF. However, these patients still have abnormalities in biomarkers and experience a significant number of HF hospitalizations, suggesting persistent HF risk.

  • myocardial recovery
  • heart failure
  • Received October 15, 2013.
  • Revision received March 18, 2014.
  • Accepted March 21, 2014.
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    Heart Failure with Recovered Ejection Fraction: Clinical Description, Biomarkers, and Outcomes
    Anupam Basuray, Benjamin French, Bonnie Ky, Esther Vorovich, Caroline Olt, Nancy K. Sweitzer, Thomas P. Cappola and James C. Fang
    Circulation. 2014;CIRCULATIONAHA.113.006855, originally published May 5, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.113.006855

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    Heart Failure with Recovered Ejection Fraction: Clinical Description, Biomarkers, and Outcomes
    Anupam Basuray, Benjamin French, Bonnie Ky, Esther Vorovich, Caroline Olt, Nancy K. Sweitzer, Thomas P. Cappola and James C. Fang
    Circulation. 2014;CIRCULATIONAHA.113.006855, originally published May 5, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.113.006855
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