Acute heart failure and left ventricular ejection fraction: evaluating its role as a prognostic tool

Acute heart failure (AHF) is characterized by significant population heterogeneity. This study aimed to compare the characteristics and outcomes of hospitalized AHF patients based on left ventricular systolic function.

We collected data on demographic characteristics, comorbidities, clinical phenotypes, precipitating factors, chronic medications, and admission laboratory parameters from hospitalized AHF patients over a 12-month period. Echocardiographic parameters were recorded within the first 48 hours of hospitalization. We also documented the need for inotropic/vasopressor support, renal replacement therapy (RRT), total hospital days, and in-hospital deaths. A 6-month follow-up was conducted to track emergency department (ED) visits, all-cause readmissions, and AHF hospitalizations among survivors who did not require RRT. Patients were categorized into two groups based on left ventricular ejection fraction (LVEF >50% and LVEF <50%).

Patients with preserved LVEF were predominantly women, had a history of atrial fibrillation (AF) and presented with higher admission systolic blood pressure and lower hemoglobin levels. In contrast, patients with reduced LVEF were more often men, had coexisting coronary artery disease (CAD), and exhibited higher admission NT-proBNP and troponin levels. They also required vasopressor or inotropic support more frequently during hospitalization. Regarding echocardiographic findings, patients with preserved LVEF had higher estimated PASP values, while those with reduced LVEF showed worse right ventricular systolic function. No significant differences were observed in left atrial volume or E/E' ratio between the two groups.

Finally, no statistically significant differences were found between the groups in terms of mortality, ED visits, readmission rates, or the need for RRT up to 6 months post-hospitalization.