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Heart failure and cardiomyopathies
Original research
Improvement of ejection fraction and mortality in ischaemic heart failure
  1. Andrew S Perry1,
  2. Douglas L Mann2,
  3. David L Brown2
  1. 1 University of Washington School of Medicine, Seattle, Washington, USA
  2. 2 Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
  1. Correspondence to Dr David L Brown, Cardiovascular Division, Washington University in St. Louis, St. Louis, MO 63110, USA; d.brown{at}wustl.edu

Abstract

Objective The frequency and predictors of improvement in left ventricular ejection fraction (LVEF) in ischaemic cardiomyopathy and its association with mortality is poorly understood. We sought to assess the predictors of LVEF improvement ≥10% and its effect on mortality.

Methods We compared characteristics of patients enrolled in The Surgical Treatment for Ischaemic Heart Failure (STICH) trial with and without improvement of LVEF ≥10% at 24 months. A logistic regression model was constructed to determine the independent predictors of LVEF improvement. A Cox proportional hazards model was created to assess the independent association of improvement in LVEF ≥10% with mortality.

Results Of the 1212 patients enrolled in STICH, 618 underwent echocardiographic assessment of LVEF at baseline and 24 months. Of the patients randomised to medical therapy plus coronary artery bypass graft surgery (CABG), 58 (19%) had an improvement in LVEF >10% compared with 51 (16%) patients assigned to medical therapy alone (p=0.30). Independent predictors of LVEF improvement >10% included prior myocardial infarction (OR 0.44, 95% CI: 0.28 to 0.71, p=0.001) and lower baseline LVEF (OR 0.94, 95% CI: 0.91 to 0.97, p<0.001). Improvement in LVEF >10% (HR 0.61, 95% CI: 0.44 to 0.84, p=0.004) and randomisation to CABG (HR 0.72, 95% CI: 0.57 to 0.90, p=0.004) were independently associated with a reduced hazard of mortality.

Conclusions Improvement of LVEF ≥10% at 24 months was uncommon in patients with ischaemic cardiomyopathy, did not differ between patients assigned to CABG and medical therapy or medical therapy alone and was independently associated with reduced mortality.

Trial registration number NCT00023595.

  • coronary artery disease surgery
  • chronic coronary disease
  • heart failure with reduced ejection fraction
  • echocardiography

https://doi.org/10.1136/heartjnl-2020-316975

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    Footnotes

    • Twitter @DavidLBrownMD

    • Contributors AP, DM and DLB each participated in the planning, conduct and reporting of the work described in this article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Data may be obtained from the Biologic Specimen and Data Repository Information Coordinating Center of the National Heart, Lung and Blood Institute under a data use agreement.