Prognostic Implications of Left-Ventricular Function Changes in Young Acute Heart Failure Patients

Abstract

Background and Objectives: Heart failure (HF) in younger patients, who are typically active, can significantly affect their quality of life. We assessed the clinical features and prognosis of younger patients with acute HF according to changes in their left ventricular function. Methods: This multi-center cohort study was conducted from March 2011 to February 2014 across 10 representative university hospitals. Adult aged <50 years at the time of admission for acute HF were included. Patients were classified into 2 groups according to changes in echocardiographic left ventricular ejection fraction (LVEF) at 1-year follow-up (improved LVEF group vs. non-improved LVEF group). The primary outcome was the incidence of all-cause mortality during the follow-up period. Results: Among the 437 patients, 14.6% experienced worsening LVEF at the 1-year follow-up. Fifty-six (12.8%) patients died during the follow-up. The non-improved LVEF group had a higher incidence of all-cause mortality than the improved LVEF groups (32.8% vs. 9.4%, p<0.001). Clinical outcomes, including all-cause death, cardiac death, and HF readmission were significantly worse in the non-improved LVEF group. Multivariate logistic regression analysis identified angiotensin converting enzyme inhibitor use at discharge as an independent predictor of reduced risk of non-improved LVEF (odds ratio, 0.37; 95% confidence interval, 0.171–0.786). Conclusions: Worsening LVEF was associated with poor clinical prognosis in younger patients hospitalized for acute HF. Clinicians should be aware of the characteristics of younger patients with acute HF and monitoring and treating changes in LVEF in younger patients with acute HF is crucial for improving clinical outcomes.