{"id":8386,"date":"2025-08-17T21:24:50","date_gmt":"2025-08-17T18:24:50","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8386"},"modified":"2025-08-17T21:24:50","modified_gmt":"2025-08-17T18:24:50","slug":"heart-failure-with-improved-ejection-fraction-hfimpef-structured-summary","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/heart-failure-with-improved-ejection-fraction-hfimpef-structured-summary\/","title":{"rendered":"Heart Failure With Improved Ejection Fraction (HFimpEF) \u2013 Structured Summary"},"content":{"rendered":"
Heart Failure With Improved Ejection Fraction (HFimpEF) \u2013 Structured Summary<\/div>\n
<\/div>\n
Published: August 14, 2025 | Source: Medscape Medical News (summary of JACC 2025 article by Riccardi et al.)<\/div>\n
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1. Definition<\/div>\n
\u2022 HFimpEF is identified in patients whose LVEF was initially \u2264 40% and later improves to > 40%.<\/span><\/div>\n
\u2022 The universal definition (2021) also includes a requirement of \u2265 10% absolute improvement in LVEF.<\/span><\/div>\n
\u2022 While guidelines like ACC\/AHA 2022 consider a rise above 40% sufficient, the universal definition is more precise.<\/span><\/div>\n
\u2022 This condition represents a state of remission\u2014not a full recovery.<\/span><\/div>\n
<\/div>\n
2. LVEF Evolution<\/div>\n
\u2022 Termed variously as LVEF Evolution, LVEF Progression, or EF Time Trend, all capture changes over time.<\/span><\/div>\n
\u2022 Improvement commonly persists for up to 10 years, but many patients eventually experience a drop in LVEF.<\/span><\/div>\n
\u2022 Those who relapse face higher risks of mortality, need for transplantation, or LVAD placement.<\/span><\/div>\n
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3. Outcomes Compared with Persistent HFrEF<\/div>\n
\u2022 HFimpEF carries about a 60% lower risk of death or hospitalization than persistent HFrEF.<\/span><\/div>\n
\u2022 Confirmed across major registries: MECKI, BIOSTAT-CHF, and ASIAN-HF.<\/span><\/div>\n
\u2022 Risk of ventricular arrhythmia is reduced\u2014but not eliminated, highlighting ongoing uncertainty around ICD\/CRT decisions.<\/span><\/div>\n
<\/div>\n
4. Outcomes Compared with HFpEF<\/div>\n
\u2022 Generally better prognosis than HFpEF: fewer readmissions and lower mortality.<\/span><\/div>\n
\u2022 However, the DELIVER trial found similar event rates to HFpEF; HFimpEF patients often required more intensive in-hospital care due to their higher baseline risk.<\/span><\/div>\n
<\/div>\n
5. Pathophysiology & Remodeling<\/div>\n
\u2022 Improvement results from reverse remodeling driven by GDMT, device therapy, revascularization, or resolution of reversible triggers (e.g., myocarditis, peripartum cardiomyopathy).<\/span><\/div>\n
\u2022 Despite EF recovery, underlying molecular and structural changes persist\u2014thus relapse remains possible.<\/span><\/div>\n
<\/div>\n
6. Predictors of Recovery<\/div>\n
\u2022 More likely in younger, female patients with non-ischemic cardiomyopathy, short disease duration, fewer comorbidities, and good therapy adherence.<\/span><\/div>\n
\u2022 Less likely in ischemic or genetic heart disease.<\/span><\/div>\n
\u2022 Genetic factors (e.g., TTN vs desmosomal mutations) affect both recovery chances and prognosis.<\/span><\/div>\n
<\/div>\n
7. Management<\/div>\n
\u2022 Continue GDMT indefinitely; withdrawal risks relapse (as shown by the TRED-HF trial).<\/span><\/div>\n
\u2022 ICD\/CRT decisions require careful individual evaluation\u2014risk persists, and recovery is not total.<\/span><\/div>\n
\u2022 Emerging treatments like SGLT2 inhibitors and finerenone show promise in symptomatic patients.<\/span><\/div>\n
<\/div>\n
8. Role of Imaging & Biomarkers<\/div>\n
\u2022 Echocardiography: GLS and left atrial strain give insight into risk of relapse.<\/span><\/div>\n
\u2022 Cardiac MRI (CMR): Evaluates fibrosis, viability, and T1 mapping changes.<\/span><\/div>\n
\u2022 Biomarkers:<\/span><\/div>\n
\u2022 NT-proBNP decline signals favorable remodeling.<\/span><\/div>\n
\u2022 ST2 (soluble suppression of tumorigenicity 2) is a fibrosis-related marker\u2014persistent elevation predicts poorer outcomes despite EF recovery.<\/span><\/div>\n
<\/div>\n
9. Reducing Communication Barriers<\/div>\n
\u2022 Effective collaboration among clinicians is critical, yet often hindered by personal reluctance or hierarchical barriers.<\/span><\/div>\n
\u2022 Establishing a confidential, case-based discussion platform\u2014where specialists can consult on complex HFimpEF cases anonymously\u2014can foster collaboration without embarrassment and improve patient management.<\/span><\/div>\n
<\/div>\n
10. Key Takeaway<\/div>\n
<\/div>\n
HFimpEF patients enjoy improved outcomes compared to those with HFrEF or HFpEF\u2014but they are not cured. Long-term therapy, surveillance, and thoughtful decision-making are essential. Collaboration\u2014especially via confidential peer discussions\u2014can further bridge gaps in care and optimize recovery.<\/div>\n
<\/div>\n
Proposal: Encourage confidential, blind case discussions among cardiologists. A neutral moderator presents the case (without revealing the sender), allowing open, respectful dialogue and exchange of expertise \u2014 free from personal sensitivities, strengthening collaboration and improving patient care.<\/div>\n
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https:\/\/click.mail.medscape.com\/?qs=56e7bf83208ccef859e8114cf6ee5712e33df48c3fe0fc097626af8a91dcf9e8b1ff263fb3303571d0afb4204fb642fd28062190cb232e06eec62b8394167d66<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

Heart Failure With Improved Ejection Fraction (HFimpEF) \u2013 Structured Summary Published: August 14, 2025 | Source: Medscape Medical News (summary of JACC 2025 article by Riccardi et al.) 1. Definition \u2022 HFimpEF is identified in patients whose LVEF was initially \u2264 40% and later improves to > 40%. \u2022 The universal definition (2021) also includes […]<\/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-8386","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8386","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=8386"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8386\/revisions"}],"predecessor-version":[{"id":8387,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8386\/revisions\/8387"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8386"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8386"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}