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HFimpEF in the Real World: Recovery Patterns and Hidden Risk Markers
Session:
Sessão de Posters 49 - Insuficiência cardíaca para além da fração de ejeção do VE melhorada e recuperada: padrões de recuperação, preditores e marcadores de risco
Speaker:
Rita Figueiredo
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.7 Chronic Heart Failure - Other
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Ana Rita M. Figueiredo; Daniel Inácio Cazeiro; Diogo Ferreira; Ana Francês; Fátima Salazar; Nuno Lousada; Joana Rigueira; Rafael Santos; Doroteia Silva; Fausto J. Pinto; Dulce Brito; João R. Agostinho
Abstract
<p style="text-align:justify"><strong>Introduction</strong>:</p> <p style="text-align:justify">A subset of patients with heart failure and reduced ejection fraction (HFrEF) demonstrates significant functional and structural recovery under optimal medical therapy (GDMT), transitioning to heart failure with improved EF (HFimpEF).<br /> Per ESC criteria, HFimpEF requires baseline LVEF ≤40%, follow-up LVEF >40% and an absolute rise ≥10 points. However, characteristics, EF trajectories, treatment patterns, and residual risk in HFimpEF remain incompletely defined.</p> <p style="text-align:justify"><strong>Methods</strong>:</p> <p style="text-align:justify">We conducted a prospective study of 270 de novo HFrEF patients at a tertiary outpatient clinic. HFimpEF was defined per ESC criteria. Baseline clinical, laboratory, echocardiographic data, GDMT use and doses were collected. LVEF was measured at baseline, 3 months, 1 year, and last follow-up. The primary endpoint was a 3-year composite of all-cause mortality and HF hospitalisation (HHF). Kaplan–Meier and Cox regression were used to access EF improvement prognostic impact.</p> <p style="text-align:justify"><strong>Results</strong>:</p> <p style="text-align:justify">Overall, 112 patients (41%) recovered EF; 158 (59%) had persistent HFrEF. HFimpEF patients were slightly younger (64 vs 67 years, p=0.04) and more often female (37% vs 23%, p=0.02), while comorbidities, AF, HF etiology, NT-proBNP, renal function, and baseline LVEF were similar. HFimpEF patients had smaller LAVI (39 vs 46 mL/m², p<0.001) and more often reached maximum ARNI (42% vs 34%, p=0.02) and MRA dosing (90% vs 81%, p=0.04).<br /> Despite identical baseline LVEF, patients with HFimpEF markedly improved EF at 3 month and kept improving slightly throughout follow-up, whereas patients with persistent HFrEF showed modest EF improvement at the 3-month mark, and only non-relevant improvement beyond 3-month - Figure 1. HFimpEF patients presented better prognosis, with almost no events when compared to persistent HFrEF patients: HFimpEF conferred a 79% lower risk of death/HHF (HR 0.21, 95% CI 0.08–0.55) – Figure 2.<br /> Within HFimpEF, only 6 adverse events occurred (2 deaths, 4 HHF). Those with events showed higher frailty (CFS 4.8 vs 3.1), lower eGFR (44 vs 74 mL/min), and much higher NT-proBNP (24,289 vs 4,759 pg/mL), identifying these as potential markers of residual risk.</p> <p style="text-align:justify"><strong>Conclusion</strong>:</p> <p style="text-align:justify">HFimpEF is common, confers a favorable prognosis and seems to be associated with higher GDMT doses. Although overall risk of events is low in this population, frailty, renal impairment and elevated NT-proBNP may identify HFimpEF patients needing closer follow-up and alternative therapies to further reduce residual risk.<br /> </p>
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