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充血性心力衰竭

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Unexpectedly Low Natriuretic Peptide Levels in Patients With Heart Failure Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure Frequency, predictors, and prognosis of ejection fraction improvement in heart failure: an echocardiogram-based registry study Percutaneous Atriotomy for Levoatrial–to–Coronary Sinus Shunting in Symptomatic Heart Failure: First-in-Human Experience Mechanical circulatory support devices for acute right ventricular failure Impact of Myocardial Scar on Prognostic Implication of Secondary Mitral Regurgitation in Heart Failure The Management of Atrial Fibrillation in Heart Failure: An Expert Panel Consensus Clinical applications of machine learning in the diagnosis, classification, and prediction of heart failure Prdm16 Deficiency Leads to Age-Dependent Cardiac Hypertrophy, Adverse Remodeling, Mitochondrial Dysfunction, and Heart Failure Association of Abnormal Left Ventricular Functional Reserve With Outcome in Heart Failure With Preserved Ejection Fraction
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Expert OpinionVolume 6, Issue 9, September 2018

JOURNAL：JACC: Heart Failure Article Link

Heart Failure With Improved Ejection Fraction-Is it Possible to Escape One’s Past?

G Gulat, JE Udelson. Keywords: HFrEF; left ventricular ejection fraction; management; outcomes

ABSTRACT

Among patients with heart failure with reduced ejection fraction, investigators have repeatedly identified a subgroup whose left ventricular ejection fraction and structural remodeling can improve to normal or nearly normal levels with or without medical therapy. This subgroup of patients with “heart failure with improved ejection fraction” has distinct clinical characteristics and a more favorable prognosis compared with patients who continue to have reduced ejection fraction. However, many of these patients also manifest clinical and biochemical signs of incomplete resolution of heart failure pathophysiology and remain at some risk of adverse outcomes, thus indicating that they may not have completely recovered. Although rigorous evidence on managing these patients is sparse, there are several reasons to recommend continuation of heart failure therapies, including device therapies, to prevent clinical deterioration. Notable exceptions to this recommendation may include patients who recover from peripartum cardiomyopathy, fulminant myocarditis, or stress cardiomyopathy, whose excellent long-term prognoses may imply true myocardial recovery. More research on these patients is needed to better understand the mechanisms that lead to improvement in ejection fraction and to guide their clinical management.

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