Eur J Heart Fail. 2022 Sep 16. doi: 10.1002/ejhf.2695. Online ahead of print.
BACKGROUND: Recent data suggest that guideline directed medical treatment of patients with heart failure with reduced ejection fraction (HFrEF) might improve clinical outcomes in patients with heart failure (HF) up to a left ventricular ejection fraction (LVEF) of 55-65%, whereas patients with higher LVEF do not seem to benefit. Recent data have shown that LVEF may have a U-shaped relation with outcome, with poorer outcome also in patients with supranormal values. This suggests that patients with supranormal LVEF may be a distinctive group of patients METHODS AND RESULTS: RELAX AHF-2 was a multicenter, placebo-controlled trial on the effects of serelaxin on 180-day cardiovascular (CV) mortality and worsening HF at day 5 in patients with acute HF. Echocardiograms were performed at hospital admission in 6128 patients. 155 (2.5%) patients were classified as HFsnEF (LVEF>65%), 1440 (23.5%) as HFpEF (LVEF 50-65%), 1353 (22.1%) as HFmrEF (LVEF 41-49%) and 3180 (51.9%) as HFrEF (LVEF<40%). Patients with HFsnEF compared to HFpEF were more often women, had higher prevalence of non-ischemic HF, had lower levels of natriuretic peptides, were less likely to be treated with beta-blockers and had higher blood urea nitrogen plasma levels. All-cause mortality was not statistically different between groups, although patients with HFsnEF had the highest numerical rate. A declining trend was seen in the proportion of 180-day deaths due to CV causes from HFrEF (290/359, 80.8%) to HFsnEF (14/24, 58.0%). The reverse was observed with death from non-cardiovascular causes. No treatment effect of serelaxin was observed in any of the subgroups.
CONCLUSIONS: In this study, only 2.5% of patients were classified as HFsnEF. HFsnEF was primarily characterized by female sex, lower natriuretic peptides and a higher risk of non-CV death. This article is protected by copyright. All rights reserved.