Abstract 128: Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction
Background: Left ventricular remodeling, as commonly measured by left ventricular ejection fraction (LVEF), is associated with clinical outcomes. Although change in LVEF over time would be anticipated to reflect response to therapy and subsequent clinical course, systematic serial measurement of LVEF is inconsistent in observational settings, and has not been systematically reported in large-scale clinical trials. Thus the incremental prognostic value of change in LVEF has not been well characterized. Methods: The Beta-Blocker Evaluation of Survival Trial (BEST, 1995-1999) collected LVEF by radionuclide ventriculography at baseline and at 3 and 12-months after randomization. Change in LVEF was defined as change from baseline to 12-month unless that value was missing, in which case the 3-month value was used. We built a series of multivariable models including 16 commonly used clinical parameters plus change in LVEF for predicting the following time to first event endpoints: all-cause mortality (ACM), cardiovascular mortality (CVM), heart failure hospitalization (HFH), and ACM or HFH. Results: Among 2,484 patients with a mean follow-up of 2-years, serial improvement in LVEF by ≥5% was the second most significant predictor (behind baseline creatinine) of outcomes (Table). LVEF change ≥5% correlated with a modest increase in C-index compared to traditional predictors (Table). Conclusions: Serial evaluation for change ≥5% LVEF predicts both survival and HFH. Further validation of the incremental prognostic value of change in LVEF for important clinical decisions, including frequency of cardiac imaging, across various heart failure populations is needed.