Long-Term Functional and Clinical Follow-Up of Heart Failure Patients with Recovered Left Ventricular Ejection Fraction After Beta-Blocker Therapy

Background—Some patients with left ventricular systolic dysfunction (LVSD) have a dramatic improvement in left ventricular ejection fraction (LVEF) after beta-blockade. No study has analyzed the long term echocardiographic and clinical follow-up of this subgroup of patients.

Methods and Results—We included in this analysis 174 consecutive patients with LVSD who had a LVEF ≥ 45% after betablockade. We performed a long-term echocardiographic follow-up (median 7.6 [4 - 9.9] years) and clinical follow-up (median 9.2 [7.2 - 10.8] years). LVEF improved from 33±8% to 54±6% after beta-blockade (p < 0.0001). At the last echocardiographic evaluation, 26% of the patients had a LVEF < 45% (mean±SD: 34±6%), while 74% still had a LVEF ≥ 45% (mean±SD: 54±6%). Independent predictors of LVEF deterioration were a post beta-blockade low LVEF, a high left ventricular end-diastolic diameter and a low heart rate after beta-blockade, and the presence of a complete left bundle branch block. In the overall study population, survival rates were 90% at 5 years and 75% at 10 years. Cardio-vascular death rate was 9%, non cardio-vascular death rate was 11%, and unknown death rate was 3%. Patients with subsequent LVEF deterioration had a higher cardiovascular mortality compared to patients with sustained recovered LVEF (22% vs 4%).

Conclusions—The long-term survival of patients with LVSD and with near-normal LVEF after betablockade is good. However, a quarter of these patients may experience a subsequent degradation of LVEF. These patients are at higher risk of cardiovascular mortality.

Source: circheartfailure.ahajournals.org