title: Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes.
abstract: BACKGROUND
  We hypothesized that patients with heart failure (HF) who recover left ventricular function (HF-Recovered) have a distinct clinical phenotype, biology, and prognosis compared with patients with HF with reduced ejection fraction (HF-REF) and those with HF with preserved ejection fraction (HF-PEF).
  
  
  RESULTS
  The Penn Heart Failure Study (PHFS) is a prospective cohort of 1821 chronic HF patients recruited from tertiary HF clinics. Participants were divided into 3 categories based on echocardiograms: HF-REF if EF was <50%, HF-PEF if EF was consistently ≥50%, and HF-Recovered if EF on enrollment in PHFS was ≥50% but prior EF was <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 brain natriuretic factor, soluble fms-like tyrosine kinase receptor-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 for death, transplantation, or ventricular assist device placement in HF-REF patients was 4.1 (95% confidence interval, 2.4-6.8; P<0.001) and in HF-PEF patients was 2.3 (95% confidence interval, 1.2-4.5; P=0.013) compared with HF-Recovered patients. The unadjusted hazard ratio for cardiac hospitalization in HF-REF patients was 2.0 (95% confidence interval, 1.5-2.7; P<0.001) and in HF-PEF patients was 1.3 (95% confidence interval, 0.90-2.0; P=0.15) compared with HF-Recovered patients. 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.
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.). anupambasuray@gmail.com.
authors.forename: Anupam
authors.initials: A
authors.lastname: Basuray
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).
authors.forename: Esther
authors.initials: E
authors.lastname: Vorovich
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).
authors.forename: Caroline
authors.initials: C
authors.lastname: Olt
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Cappola
authors.affiliation: From the University Hospitals Case Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH (A.B., J.C.F.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH (A.B.); Department of Biostatistics and Epidemiology (B.F., B.K.) and Penn Cardiovascular Institute (B.F., B.K., E.V., C.O., T.P.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Cardiovascular Medicine, University of Arizona, Tucson (N.K.S.); and Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.).
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D019210:Troponin I / Q000097:blood; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D003404:Creatinine; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: heart failure; myocardium; ventricular remodeling