RESUMEN
Introducción: La insuficiencia cardiaca (IC) con fracción de eyección (FE) recuperada está emergiendo como un subtipo de IC diferenciada. Existe poca información sobre su perfil clínico en centros que no son referencia. Métodos: Analizamos la evolución y pronóstico de los pacientes afectos de IC con FE recuperada seguidos prospectivamente en una unidad de IC de un hospital no terciario. Resultados: Se ha seguido a 431 pacientes con FE deprimida (mediana 50 meses; edad media de 70,3±12,2 años; el 79,3% eran varones.) El 26,9% normalizaron la FEVI; el 76,7% de ellos en el primer año. Comparados con los pacientes que no normalizaron la FEVI, eran más jóvenes, el origen isquémico de la IC era menos frecuente y presentaban menos comorbilidad. Su pronóstico es mejor (mediana de supervivencia 85,2± 2,1vs. 74,2± 1,9 meses, log-rank χ2 11,5; p = 0,001; hazard ratio de 0,37, intervalo de confianza [IC] del 95%: 0,21-0,67; p = 0,002). Las causas de muerte principalmente no estaban relacionadas con IC. Las variables predictoras de normalización de la FEVI fueron la edad (odds ratio [OR] para más de 69 años 0,98; IC 95%: 0,96-0,99; p = 0,025), origen no isquémico (OR 1,12; IC 95%: 1,01-1,21; p = 0,003) y prescripción de antialdosterónicos (OR 1,89; IC 95%: 1,05-3,26; p = 0,023). Conclusión: La normalización de la FE en pacientes con IC con FE reducida es frecuente y presenta unas características basales, evolución y pronóstico más favorables que la IC con persistencia de FE reducida. Investigaciones futuras deberán confirmar su historia natural y tratamiento óptimo
Introduction: Heart failure (HF) with recovered ejection fraction (EF) is emerging as a different HF subtype. There is little information about his clinical profile in hospitals that are not a reference. Methods: We analysed characteristics and prognosis in patients with recovered HF followed prospectively in the HF Unit of a non-tertiary hospital. Results: A total of 431 patients with HF with reduced EF were followed (median 50 months, 79.3% males, mean age 70.3±12.2years). Of the patients, 26.9% (N 116) recovered EF, mainly in the first year of follow-up (76.7%). Compared with patients that did not recovered EF in the follow-up, they were younger, rate of ischemic origin of cardiomyopathy was less frequent and presented less comorbidity. Mortality was lower in patients with recovered HF (survival median of 85.2±2.1 vs. 74.2±1.9 months [log-rank χ2 11.5, P=0.001], hazard ratio 0.37, 95% confidence interval [CI]: 0.21-0.67, P=0.002). Aetiology of deaths was not mainly secondary to HF. Younger age of 68 years (odds ratio [OR] 0-98, 95% CI: 0.96-0,99; P=0.025), ischemic origin (OR 1.12, 95% CI: 1.01-1.21; P=0.003) and use of aldosterone antagonists (OR 1.89, 95% CI: 1.09-3.26; P=0.023) were the variables independently associated to normalisation of EF. Conclusion: HF with recovered EF is a frequent phenomenon. It has a more favourable clinical course, prognosis and basal characteristics than HF with persistent reduced EF. Further studies are needed to identify natural history and optimal medications for HF-recovered patients
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Insuficiencia Cardíaca Sistólica/diagnóstico , Pronóstico , Volumen Sistólico , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Estudios Prospectivos , Oportunidad Relativa , Insuficiencia Cardíaca/etiología , Modelos LogísticosRESUMEN
INTRODUCTION: Heart failure (HF) with recovered ejection fraction (EF) is emerging as a different HF subtype. There is little information about his clinical profile in hospitals that are not a reference. METHODS: We analysed characteristics and prognosis in patients with recovered HF followed prospectively in the HF Unit of a non-tertiary hospital. RESULTS: A total of 431 patients with HF with reduced EF were followed (median 50 months, 79.3% males, mean age 70.3±12.2years). Of the patients, 26.9% (N 116) recovered EF, mainly in the first year of follow-up (76.7%). Compared with patients that did not recovered EF in the follow-up, they were younger, rate of ischemic origin of cardiomyopathy was less frequent and presented less comorbidity. Mortality was lower in patients with recovered HF (survival median of 85.2±2.1 vs. 74.2±1.9 months [log-rank χ2 11.5, P=0.001], hazard ratio 0.37, 95% confidence interval [CI]: 0.21-0.67, P=0.002). Aetiology of deaths was not mainly secondary to HF. Younger age of 68 years (odds ratio [OR] 0-98, 95% CI: 0.96-0,99; P=0.025), ischemic origin (OR 1.12, 95% CI: 1.01-1.21; P=0.003) and use of aldosterone antagonists (OR 1.89, 95% CI: 1.09-3.26; P=0.023) were the variables independently associated to normalisation of EF. CONCLUSION: HF with recovered EF is a frequent phenomenon. It has a more favourable clinical course, prognosis and basal characteristics than HF with persistent reduced EF. Further studies are needed to identify natural history and optimal medications for HF-recovered patients.