Óscar Otero-García

Aims: Heart failure (HF) often coexists with chronic kidney disease (CKD), impacting prognosis. This study aims to evaluate renal function trajectories and their impact on major clinical outcomes in a cohort of patients hospitalised for ‘de novo’ HF with reduced ejection fraction (HFrEF). Methods: This is a prospective cohort study that included patients hospitalised for ‘de novo’ HFrEF at two university hospitals. Renal function was assessed using the CKD-Epidemiology Collaboration formula. Total mortality and the combined total mortality and HF readmissions were evaluated during follow-up. Results: Of 370 patients, 306 were eligible. At discharge, 24.6% had estimated glomerular filtration rate (eGFR) 2 . Higher eGFR at discharge was associated with better outcomes. During follow-up, 79.1% showed eGFR ≥45 mL/min/1.73 m ² . Patients with stable or improved eGFR had lower total mortality and HF readmission rates. Factors associated with renal function improvement or stabilisation included less prior CKD, hypertension and younger age, higher eGFR values at discharge and more use of quadruple therapy at the end of uptitration period. Conclusions: In patients with ‘de novo’ HFrEF, renal function deterioration at discharge correlated with poorer outcomes. However, stabilisation or improvement during follow-up was linked to better prognosis. Routine renal function assessment is crucial in HFrEF management, guiding personalised treatment strategies to mitigate renal function decline and improve patient care.

Background/Objectives: Patients hospitalized for de novo heart failure with reduced ejection fraction (HFrEF) may experience improvement in left ventricular function, a phenomenon associated with improved morbidity and mortality outcomes. However, the factors influencing this improvement remain unclear. This study aimed to investigate the association between clinical and therapeutic factors and short-term improvement or recovery of left ventricular ejection fraction (LVEF) in patients hospitalized with newly diagnosed heart failure with reduced ejection fraction (HFrEF). Methods: This was a prospective observational study conducted in two referral centers in Spain. All patients admitted with de novo HFrEF between March 2021 and December 2023 were included. Improved myocardial function (HFimpEF) was defined as an initial LVEF ≤ 40% and a follow-up echocardiogram showing LVEF > 40%, with an increase of ≥10 points from baseline. Results: In total, 157 patients (63.3%) met the criteria for HFimpEF. Among the various etiologies of heart failure, significant differences were found between groups for tachycardiomyopathy (HFimpEF: 29.3% vs. non-HFimpEF: 13.1%, p = 0.006), valvular (HFimpEF: 7.6% vs. non-HFimpEF: 1.1%, p = 0.05), and ischemic (HFimpEF: 17.2% vs. non-HFimpEF: 43.9%, p < 0.0001) etiologies. Multivariate analysis showed that non-ischemic etiologies significantly favored myocardial improvement compared to ischemic cardiomyopathy. NT-proBNP values were consistently higher in the non-HFimpEF group at all time points measured with statistically significant differences, except at admission. Event-free survival curves (hospitalization for HF, worsening HF, and all-cause mortality) diverged early, showing statistically significant differences between groups. Conclusions: Overall, 63% of patients hospitalized for de novo HFrEF achieved myocardial improvement within an average of 3–4 months, with improvement favored by valvular and tachycardiomyopathy etiologies. This improvement has a significant prognostic impact.

This study aims to analyze whether NT-proBNP at admission and discharge in de novo heart failure (HF) with reduced ejection fraction (HFrEF) is associated with myocardial recovery. This is a prospective observational study in two centers. Patients admitted with de novo HFrEF between 2021 and 2023 were included. HF with improved ejection fraction (HFimpEF) was defined as an improvement of at least 10 points with an ejection fraction >40%. Of the 248 patients who were included, 63.3% met HFimpEF criteria at follow-up, with no differences in age or gender. There were no differences in NT-proBNP at admission, but there were at discharge, where its value was inversely associated with myocardial recovery (OR 0.99 for each increase in the square root of NT-proBNP, 95% CI 0.98–0.99, p = 0.048). An NT-proBNP > 10,000 pg/mL at discharge was independently associated with reduced ventricular recovery (OR 0.28, 95% CI 0.07–0.94, p = 0.043). A smaller reduction in NT-proBNP during admission decreased the probability of recovery (OR 0.13, 95% CI 0.03–0.61, p = 0.010). In conclusion, in admissions for de novo HFrEF, NT-proBNP at discharge is inversely associated with myocardial recovery; a level > 10,000 pg/mL is an independent predictor for a lack of recovery, while a greater reduction increases the likelihood of recovery.

Left ventricular ejection fraction (LVEF) recovery after an ST-segment elevation myocardial infarction (STEMI) identifies a group of patients with a better prognosis. However, the association between long-term outcomes and LVEF recovery among patients with STEMI undergoing primary percutaneous coronary intervention (PCI) has not yet been well investigated. Our study aims to detect differences in long-term all-cause and cardiovascular mortality between patients who recover LVEF at 1-year post-PCI and those who do not, and search for predictors of LVEF recovery. This is a retrospective, single-centre study of 2170 consecutive patients admitted for STEMI in which primary PCI is performed. LVEF was determined at admission and at 1-year follow-up. The primary outcomes were long-term all-cause and cardiovascular mortality. Among the 2168 patients with baseline LVEF data, 822 (38%) had a LVEF < 50% and 1346 (62%) ≥ 50%. Among those with LVEF < 50%, LVEF data at 1-year were available in 554, and 299 (54.0%) presented with complete recovery (LVEF ≥ 50%). LVEF recovery was associated with a reduction in long-term all-cause and cardiovascular mortality (P < 0.0001). Female sex, treatment with ACEIs, lower creatinine levels, infarct-related artery different from the left main or left anterior descendent artery, and absence of prior ischaemic heart disease were independently associated with LVEF recovery. Nearly 40% of patients with STEMI undergoing primary PCI presented with LVEF depression at hospital admission. Among them, LVEF recovery at 1-year occurred in more than 50% and was independently associated with a significant decrease in long-term all-cause and cardiovascular mortality.