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Parameters associated with improvement of systolic function in patients with heart failure
  1. Liv Borum Schöps1,2,3,
  2. Morten Sengeløv1,2,
  3. Daniel Modin1,2,
  4. Peter Godsk Jørgensen1,4,
  5. Niels Eske Bruun4,5,
  6. Thomas Fritz-Hansen1,
  7. Gunnar Gislason1,
  8. Emil Wolsk1,
  9. Morten Schou2,
  10. Tor Biering-Sørensen1,2
  1. 1Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
  2. 2Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
  4. 4Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  5. 5Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
  1. Correspondence to Dr Liv Borum Schöps, Department of Cardiology, University of Copenhagen, Kobenhavn, Denmark; liv.schoeps{at}


Aims Identifying clinical and echocardiographic parameters associated with improvement in systolic function in outpatients with heart failure with reduced ejection fraction (HFrEF) could lead to more targeted treatment improving systolic function and outcome.

Methods In a retrospective cohort study, echocardiographic examinations from the first and final visit of 686 patients with HFrEF at the heart failure clinic at Gentofte Hospital were retrieved and analysed. Parameters associated with left ventricular ejection fraction (LVEF) improvement and survival according to LVEF improvement were assessed using linear regression and Cox regression, respectively. Beta-coefficients (β-coef) are standardised. Strain values are absolute.

Results While undergoing heart failure treatment, 559 (81.5%) patients improved systolic function (ΔLVEF >0%), with 100 (14.6%) being super responders defined by LVEF improvement >20%. After multivariable adjustment, LVEF improvement was significantly associated with a less impaired global longitudinal strain (β-coef 0.25, p<0.001), higher tricuspid annular plane systolic excursion (β-coef 0.09, p=0.018), smaller left ventricular internal dimension in diastole (β-coef −0.15, p=0.011), lower E-wave/A-wave ratio (β-coef −0.13, p=0.003), higher heart rate (β-coef 0.18, p<0.001) and absence of ischaemic cardiomyopathy (β-coef −0.11, p=0.010) and diabetes (β-coef −0.081, p=0.033) at baseline. Mortality incidence rates differed with LVEF improvement (ΔLVEF <0% vs ΔLVEF >0%, 8.3 vs 4.3 per 100 person years, p=0.012). Greater improvement in LVEF was associated with significantly lower mortality risk (tertile 1 vs tertile 3, HR 3.23, 95% CI 1.39 to 7.51, p=0.006).

Conclusion In this outpatient HFrEF cohort, most patients improved systolic function. Heart failure aetiology, comorbidities and echocardiographic measures of heart structure and function were significantly, independently associated with future LVEF improvement. Greater LVEF improvement was significantly associated with lower mortality.

  • heart failure
  • echocardiography
  • heart failure, systolic

Data availability statement

Data may be obtained from a third party and are not publicly available. No data are available.

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Data availability statement

Data may be obtained from a third party and are not publicly available. No data are available.

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  • Contributors Study planning, conception and design was conceived by LBS, MS, PGJ and TB-S. All authors have participated in analysing and interpretation of the data. All authors revised the paper. All authors have approved this paper in its final submitted form. LBS was guarantor of the study.

  • 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 PGJ has received lecture fees from Novo Nordisk and AstraZeneca. TB-S: reports receiving research grants from Sanofi Pasteur, and GE Healthcare, is a Steering Committee member of the Amgen financed GALACTIC-HF trial, on advisory boards for Sanofi Pasteur and Amgen, and speaker honorariums from Novartis and Sanofi Pasteur.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.