Improvement but no cure of left ventricular systolic dysfunction in treated heart failure patients.
BACKGROUND
Recent advances in pharmacological and pacemaker-based treatments for heart failure (HF) have brought about significant improvements in left ventricular function.


OBJECTIVE
To identify the proportion of treated systolic HF patients in whom left ventricular systolic function improves and/or returns to normal.


METHODS
This was a retrospective analysis of 221 HF patients. Improvement in left ventricular function was defined as an improvement in ejection fraction (LVEF) of > or =10% on echocardiography. Return to normal was defined as an improvement of LVEF to > or =50% and a reduction in left ventricular end diastolic diameter to < or =55 mm. Changes in BNP were also recorded.


RESULTS
Improvement in LVEF was observed in 44.3% of patients and return to normal systolic function in 10.9%, only 2.3% had both a return to normal echocardiographic parameters and a BNP<100 pg/ml. A higher percentage of the improved group were on target doses of beta-blockers (p=0.004). Baseline BNP was not a predictor of improvement. There was a trend towards a reduction in HF readmissions in the improved group (p=0.07) but no difference in the risk of death or all-cause readmission.


CONCLUSIONS
While a substantial proportion of treated HF patients have an improvement in left ventricular function over time, only a small proportion return to normal dimensions and LVEF, underlining the permanent nature of ventricular damage in the vast majority of patients.
Heart Failure Unit, Department of Cardiology, St Vincent's University Hospital, and University College Dublin, Dublin 4, Ireland.
Niamh F
NF
Murphy
Christina
C
O'Loughlin
Mark
M
Ledwidge
Dermot
D
McCaffrey
Kenneth
K
McDonald
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000209:etiology / Q000503:physiopathology*
D002317:Cardiovascular Agents; D020097:Natriuretic Peptide, Brain