Improvement of Left Ventricular Ejection Fraction in US Veterans With HF

Female doctor checks heartbeat of a senior man
Researchers sought to evaluate left ventricular ejection fraction in patients in the Veterans Affairs health system via a bioinformatics approach.

Findings from a study published in the American Heart Journal Plus: Cardiology Research and Practice underscored the complex gene-by-environment-by-treatment interaction which governs left ventricular (LV) function in heart failure (HF).

Investigators at Sandford University evaluated data from the Veterans Affairs (VA) health system, including non-VA facilities where the VA paid for care. Factors associated with HF with improved ejection fraction (HFimpEF) were investigated. For this study, HFimpEF was defined as a final LVEF of 40% or greater.

At baseline, patients with HFimpEF (n=39,994) and HFrEF (n=66,420) were aged mean 67.5±11.3 and 68.5±11.4 years (P <.0001), 97.4% and 98.5% were men (P <.0001), 73.3% and 70.1% were White (P =.049), 46.2% and 41.1% had an emergency department visit in the prior year (P <.0001), and 11.2% and 8.2% had any inpatient admission (P <.0001), respectively.

Improvement in LVEF was associated with 53 of the 71 demographic and clinical characteristic comparisons tested in this study.

The features which had the highest positive relationship with HFimpEF were first EF per 10% (odds ratio [OR], 1.74; P <.0001), atrial fibrillation within the prior 2 years (OR, 1.53; P <.0001), and 5 years since diagnosis compared with 6 months (OR, 1.48; P <.0001). The features most negatively correlated with HFimpEF were high B-type natriuretic peptide (BNP) to natriuretic peptide-proBNP (NT-proBNP) ratio compared with BNP of 100 pg/mL or less/NT-proBNP of 400 pg/mL or less (OR range, 0.28-0.54; P <.0001), missing hemoglobin data vs hemoglobin of 10 g/dL or less (OR, 0.60; P <.0001), and ischemic heart disease within the last 2 years (OR, 0.65; P <.0001).

The significant variables identified in this analysis had an area under the receiving operator characteristic curve of 0.70, indicating modest discriminatory capacity for predicting improvement of LVEF on the basis of clinical and demographic characteristics.

The major limitation of this study is the lack of an independent validation cohort.

“This large and detailed dataset facilitated an in-depth analysis of a significant number of factors associated with LVEF improvement,” the study authors wrote. “Despite the large number of variables identified, their combined predictive value for recuperation of LVEF in HF remained modest indicating that multiple other determinants of LVEF recovery exist and may include interactions between genetic and environmental factors, as well as medical and procedural therapies.”


Nallamshetty S, Castillo A, Nguyen A, Haddad F, Heidenreich P. Clinical predictors of improvement in left ventricular ejection fraction in U. S. veterans with heart failure. Am Heart J Plus. Published online July 22, 2022. doi:10.1016/j.ahjo.2022.100183