Clinical determinants and long-term survival in heart failure with supra-normal ejection fraction. Insights from LECRA-HF registry

Heart failure with supra-normal ejection fraction (HFsnEF), defined as HF with left ventricular ejection fraction (LVEF) >65%, constitutes a novel HF category. However, its clinical characteristics and long-term outcomes remain insufficiently elucidated.

We sought to characterize Polish HFsnEF patients and provide their long-term mortality.

Of 1186 patients enrolled in the single-center Lesser Poland Cracovian Heart Failure (LECRA-HF) Registry between 2009 and 2019 years 261 (22%) were classified as HF with LVEF ≥50%. 40 (15.3%) of them were classified as HFsnEF, and the remaining 221 (84.7%) as HFpEF. Baseline characteristics, prior cardiovascular treatment, laboratory and echocardiographic measurements have been collected during index hospitalization. The long-term follow-up of all-cause mortality was obtained from the National Death Registry.

HFsnEF patients were less frequently hypertensive (75 vs 88.2%, P=0.026) and they were less often treated with mineralocorticoid receptor antagonists (25 vs 46.2%, P=0.013) and loop diuretics (60 vs 76%, P=0.017). The Kaplan-Meier analysis showed that all-cause mortality is higher in HFsnEF than in HFpEF (65 vs 55.2%, P=0.044). The independent predictors of long-term mortality were age and HFsnEF diagnosis (hazard ratio [HR] 1.037, 95% confidence interval [CI] 1.018-1.056; HR 1.665, 95% CI 1.063-2.608, respectively).