Association of changes in the left ventricular ejection fraction with physical function characteristics and survival in patients with heart failure

Background: The relationship between the degree of change (Δ) in the left ventricular ejection fraction (ΔLVEF) and physical function and survival remains unclear. Therefore, we assessed the associations among physical characteristics, the ΔLVEF, and physical function and survival in response to heart failure (HF) treatment. Methods: In this retrospective cohort analysis, patients with HF aged ≥65 years who underwent cardiopulmonary exercise testing (CPX) were classified into three groups based on the LVEF (recovered [HFrecEF], worsened [HFworEF], and unchanged [HFuncEF]). CPX measured the peak oxygen uptake (VO ₂ ) and peak minute ventilation (VE). Results: Overall, 191 patients were included. Age, height, and weight did not differ significantly between the groups. The HFworEF group showed significant deterioration in blood urea nitrogen, creatinine, brain natriuretic hormone, and estimated glomerular filtration levels. Oral administration of beta-blockers was significantly higher in the HFrecEF group than in the other groups. Based on the Kruskal–Wallis test, the three groups differed significantly in terms of the peak VO ₂ (HFrecEF, median 806.5; HFworEF, 600.0; and HFuncEF, 749.0; P <.05), heart rate (HFrecEF, 121.0; HFworEF, 100.0; and HFuncEF, 107.0; P <.05), and VE (HFrecEF, 35.3; HFworEF, 25.8; and HFuncEF, 34.0; P <.01). Furthermore, the peak VO ₂ (ρ: 0.25) and peak VE (ρ: 0.18) were not correlated with the ΔLVEF (all P <.01). The HFrecEF group had a significantly lower mortality rate at 60 months compared with the HFuncEF group (log-rank test, P <.05). Conclusions: The HFworEF group had poor heart and kidney function and low physical function. The HFrecEF category had a relatively favourable long-term mortality rate at 60 months. ΔLVEF was not correlated with physical function.