Heart failure with improved left ventricular ejection fraction: Prevalence, diagnosis, management options, and prognosis

Abstract

The phenotype of heart failure with improved left ventricular ejection fraction (HFiLVEF) can be considered if the following conditions are met: 1) a history of LV ejection fraction (EF) of less than or equal to 40%; 2) an improvement of LVEF ≥ 10% compared to baseline; 3) an LVEF of 40% or greater achieved on the second ECHO. This article provides comprehensive up-to-date information on the prevalence of this HF phenotype among patients with HF and reduced LVEF, with an incidence ranging from 10% to 40%. Attention is focused on the clinical characteristics of patients, and the leading echocardiographic and biochemical prognostic factors associated with increased LVEF. The female gender, no history of coronary artery disease (CAD), myocardial infarction, and diabetes mellitus, along with LV and LA smaller end-diastolic and end-systolic dimensions and lower baseline values of biomarkers such as natriuretic peptides, sST2, troponin, and galectin-3 have been shown to predict the course of HF with reduced ejection fraction (HFrEF) more accurately and allow better individualization of therapy for patients. The article discusses prognosis of patients with HFiEF, which, according to many researchers, is more favourable compared to patients with reduced LVEF. A modern, comprehensive, pharmaceutical disease-modifying treatment strategy for this group of patients is presented. It aims to stabilize the course of HF, improve patient’s quality of life, and reduce the risk of hospitalization and mortality. This strategy considers the use of valsartan and sacubitril, beta-blockers, angiotensin-converting enzyme inhibitors, sodium-glucose cotransporter-2 inhibitors, and aldosterone antagonists. The prospects of studying the HFiEF phenotype are discussed.