{"id":8246,"date":"2025-08-06T18:53:17","date_gmt":"2025-08-06T15:53:17","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8246"},"modified":"2025-08-06T18:53:17","modified_gmt":"2025-08-06T15:53:17","slug":"heart-failure-with-improved-ejection-fraction-definitions-epidemiology-and-management-journal-of-the-american-college-of-cardiology-jacc-volume-85-issue-24-2025","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/heart-failure-with-improved-ejection-fraction-definitions-epidemiology-and-management-journal-of-the-american-college-of-cardiology-jacc-volume-85-issue-24-2025\/","title":{"rendered":"Heart Failure With Improved Ejection Fraction: Definitions, Epidemiology, and Management Journal of the American College of Cardiology (JACC), Volume 85, Issue 24, 2025."},"content":{"rendered":"
Heart Failure With Improved Ejection Fraction: Definitions, Epidemiology, and Management<\/div>\n
Journal of the American College of Cardiology (JACC), Volume 85, Issue 24, 2025.<\/div>\n
<\/div>\n
Key Points:<\/div>\n
1. What is HFimpEF?<\/span><\/div>\n
\u2022 HFimpEF (Heart Failure with improved Ejection Fraction) is when a patient\u2019s LVEF was once \u226440% and later improves to >40%, with at least a \u226510% absolute increase in LVEF.<\/span><\/div>\n
\u2022 It is now recognized as a separate heart failure (HF) phenotype.<\/span><\/div>\n
2. Why It Matters:<\/span><\/div>\n
\u2022 Despite LVEF recovery, these patients still carry risks for adverse cardiovascular outcomes and require ongoing follow-up.<\/span><\/div>\n
3. How Common Is It?<\/span><\/div>\n
\u2022 Estimated prevalence is ~23% among HF patients over ~3.8 years of follow-up, based on a meta-analysis of 9 studies.<\/span><\/div>\n
\u2022 Increased prevalence reflects broader use of guideline-directed medical therapy (GDMT) and standardized definitions.<\/span><\/div>\n
4. Cardiac Remodeling (Reverse Remodeling):<\/span><\/div>\n
\u2022 LVEF recovery is linked to structural and molecular improvement in the heart muscle and reversal of fibrosis.<\/span><\/div>\n
\u2022 Reverse remodeling is key to prognosis, but does not mean full recovery.<\/span><\/div>\n
5. Underlying Causes:<\/span><\/div>\n
\u2022 Causes vary: ischemic heart disease, myocarditis, toxic cardiomyopathy, and idiopathic forms.<\/span><\/div>\n
\u2022 Some causes are more likely to reverse, others (like genetic or infiltrative diseases) carry a higher relapse risk.<\/span><\/div>\n
6. Imaging & Biomarkers:<\/span><\/div>\n
\u2022 Advanced imaging (e.g., cardiac MRI) helps assess potential for recovery.<\/span><\/div>\n
\u2022 Biomarkers such as NT-proBNP and troponin can aid in predicting reverse remodeling and managing treatment.<\/span><\/div>\n
7. Medical Therapy in HFimpEF:<\/span><\/div>\n
\u2022 GDMT remains critical even after recovery (ACEi\/ARB\/ARNI, beta-blockers, MRAs, SGLT2i).<\/span><\/div>\n
\u2022 Stopping meds is not currently recommended due to relapse risk.<\/span><\/div>\n
8. DELIVER and FINEARTS-HF Trials:<\/span><\/div>\n
\u2022 These are the first RCTs to provide dedicated insights into treating HFimpEF.<\/span><\/div>\n
\u2022 DELIVER post hoc analysis showed that 25% of patients with HFimpEF were undertreated (received \u22641 HF medication).<\/span><\/div>\n
9. Special Populations:<\/span><\/div>\n
\u2022 Ischemic HFimpEF: Needs revascularization + secondary prevention (statins, antiplatelets).<\/span><\/div>\n
\u2022 Genetic Cardiomyopathies: Some mutations (e.g., LMNA, TTN, FLNC) are linked to arrhythmic risk despite LVEF recovery.<\/span><\/div>\n
\u2022 ICD may still be warranted in some.<\/span><\/div>\n
10. Role of Genetic Testing:<\/span><\/div>\n
<\/div>\n
\u2022 Useful in familial or idiopathic cases.<\/span><\/div>\n
\u2022 Helps in identifying patients at high risk of late deterioration or arrhythmias.<\/span><\/div>\n
<\/div>\n
11. Ongoing Trials:<\/span><\/div>\n
<\/div>\n
\u2022 PROSPER-HF: Sacubitril\/valsartan vs. valsartan in HFimpEF.<\/span><\/div>\n
\u2022 WEAN-HF: Evaluating when\/if GDMT can be safely withdrawn.<\/span><\/div>\n
\u2022 Other trials explore therapy tapering and personalized care pathways.<\/span><\/div>\n
<\/div>\n
12. Unresolved Questions:<\/span><\/div>\n
<\/div>\n
\u2022 What\u2019s the best threshold for defining HFimpEF?<\/span><\/div>\n
\u2022 Can therapy be withdrawn safely?<\/span><\/div>\n
\u2022 How to stratify risk more accurately?<\/span><\/div>\n
\u2022 What is the role of cardiac MRI vs. echo in follow-up?<\/span><\/div>\n
<\/div>\n
13. Conclusions:<\/span><\/div>\n
<\/div>\n
\u2022 HFimpEF is a dynamic condition: LVEF may improve, but patients remain vulnerable.<\/span><\/div>\n
\u2022 Continued GDMT and surveillance are essential.<\/span><\/div>\n
\u2022 New evidence is emerging, but many clinical decisions still rely on expert opinion and limited data.<\/span><\/div>\n
<\/div>\n
DOI: https:\/\/doi.org\/10.1016\/j.jacc.2025.03.544<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

Heart Failure With Improved Ejection Fraction: Definitions, Epidemiology, and Management Journal of the American College of Cardiology (JACC), Volume 85, Issue 24, 2025. Key Points: 1. What is HFimpEF? \u2022 HFimpEF (Heart Failure with improved Ejection Fraction) is when a patient\u2019s LVEF was once \u226440% and later improves to >40%, with at least a \u226510% […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8246","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8246","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8246"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8246\/revisions"}],"predecessor-version":[{"id":8247,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8246\/revisions\/8247"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8246"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8246"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8246"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}