@article{275386fca0df4c40b653673ff8455675,
title = "Characteristics and clinical outcomes of patients with acute heart failure with a supranormal left ventricular ejection fraction",
abstract = "Aim: Recent data suggest that guideline-directed medical therapy of patients with heart failure (HF) with reduced ejection fraction (HFrEF) might improve clinical outcomes in patients with HF up to a left ventricular ejection fraction (LVEF) of 55–65%, whereas patients with higher LVEF do not seem to benefit. Recent data have shown that LVEF may have a U-shaped relation with outcome, with poorer outcome also in patients with supranormal values. This suggests that patients with supranormal LVEF may be a distinctive group of patients.Methods and results: RELAX-AHF-2 was a multicentre, placebo-controlled trial on the effects of serelaxin on 180-day cardiovascular (CV) mortality and worsening HF at day 5 in patients with acute HF. Echocardiograms were performed at hospital admission in 6128 patients: 155 (2.5%) patients were classified as HF with supranormal ejection fraction (HFsnEF; LVEF >65%), 1440 (23.5%) as HF with preserved ejection fraction (HFpEF; LVEF 50–65%), 1353 (22.1%) as HF with mildly reduced ejection fraction (HFmrEF; LVEF 41–49%) and 3180 (51.9%) as HFrEF (LVEF <40%). Patients with HFsnEF compared to HFpEF were more often women, had higher prevalence of non-ischaemic HF, had lower levels of natriuretic peptides, were less likely to be treated with beta-blockers and had higher blood urea nitrogen plasma levels. All-cause mortality was not statistically different between groups, although patients with HFsnEF had the highest numerical rate. A declining trend was seen in the proportion of 180-day deaths due to CV causes from HFrEF (290/359, 80.8%) to HFsnEF (14/24, 58.3%). The reverse was observed with death from non-CV causes. No treatment effect of serelaxin was observed in any of the subgroups.Conclusions: In this study, only 2.5% of patients were classified as HFsnEF. HFsnEF was primarily characterized by female sex, lower natriuretic peptides and a higher risk of non-CV death.",
keywords = "Acute heart failure, Clinical outcome, Heart failure with supranormal ejection fraction, Serelaxin",
author = "{van Essen}, {Bart J.} and Jasper Tromp and {ter Maaten}, {Jozine M.} and Greenberg, {Barry H.} and Claudio Gimpelewicz and Felker, {G. Michael} and Davison, {Beth A.} and Thomas Severin and Pang, {Peter S.} and Gad Cotter and Teerlink, {John R.} and Marco Metra and Voors, {Adriaan A.}",
note = "Funding Information: : J.T. is supported by the National University of Singapore Start‐up grant, the tier 1 grant from the Ministry of Education and the CS‐IRG New Investigator Grant from the National Medical Research Council; has received consulting or speaker fees from Daiichi‐Sankyo, Boehringer Ingelheim, Roche Diagnostics and Us2.ai, owns patent US‐10702247‐B2 unrelated to the present work. B.H.G. has received honoraria for participation on the Executive Committee for RELAX‐AHF2. C.G. is Novartis employee. G.M.F. has received research grants from NHLBI, American Heart Association, Amgen, Bayer, BMS, Merck, Cytokinetics, and CSL‐Behring; he has acted as a consultant to Novartis, Amgen, BMS, Cytokinetics, Medtronic, Cardionomic, Boehringer Ingelheim, American Regent, Abbott, AstraZeneca, Reprieve, Myovant, Sequana, Windtree Therapuetics, and Whiteswell, and has served on clinical endpoint committees/data safety monitoring boards for Amgen, Merck, Medtronic, EBR Systems, V‐Wave, LivaNova, Siemens, and Rocket Pharma. B.A.D. and G.C. are employees of Momentum Research, Inc. which has received grants from Abbott Laboratories, Amgen, Celyad, Cirius Therapeutics Inc., Corteria Pharmaceuticals, Roche Diagnostics Inc., Sanofi, Windtree Therapeutics Inc. and XyloCor Therapeutics. T.S. is employee and shareholder of Novartis. A.A.V. and/or his institution received consultancy fees and/or research grants from Amgen AstraZeneca, Bayer AG, Boehringer Ingelheim, BMS, Cytokinetics, Myokardia, Merck, Novo Nordisk, Novartis, Roche Diagnostics. All other authors have nothing to disclose. Conflict of interest Publisher Copyright: {\textcopyright} 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",
year = "2023",
month = jan,
doi = "10.1002/ejhf.2695",
language = "English",
volume = "25",
pages = "35--42",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Wiley",
number = "1",
}