Clinical management of heart failure with improved ejection fraction:treatment and maintenance
10.3969/j.issn.1674-8115.2025.04.012
- VernacularTitle:射血分数改善型心力衰竭的临床管理:治疗与维持
- Author:
Tianyun XU
1
;
Yiming SHEN
1
;
Meng JIANG
1
Author Information
1. 上海交通大学医学院附属仁济医院心内科,上海 200127
- Publication Type:Journal Article
- Keywords:
heart failure;
heart failure with improved ejection fraction(HFimpEF);
heart failure with reduced ejection fraction(HFrEF);
prognosis
- From:
Journal of Shanghai Jiaotong University(Medical Science)
2025;45(4):493-499
- CountryChina
- Language:Chinese
-
Abstract:
In patients with heart failure with reduced ejection fraction(HFrEF),some individuals demonstrate significant improvement in left ventricular ejection fraction(LVEF)during subsequent evaluations after treatment.The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America(AHA/ACC/HFSA)heart failure management guidelines introduced the term"heart failure with improved ejection fraction(HFimpEF)"to describe patients with prior LVEF≤40%that subsequently increased above 40%during follow-up.Studies indicate that HFimpEF patients exhibit lower all-cause mortalities and heart failure rehospitalization rates,with a significantly better prognosis compared to HFrEF patients,establishing HFimpEF as a staged therapeutic target for HFrEF.Current discussion on HFimpEF primarily focuses on two aspects:characteristics of the target population and effective methods for LVEF improvement,and maintenance strategies for cardiac function preservation in HFimpEF patients;particularly the latter lacks clear clinical-guideline recommendations.Therefore,reviewing existing research to systematically summarize therapeutic strategies that promote the HFrEF-to-HFimpEF transition and effective maintenance approaches for HFimpEF becomes crucial.This article comprehensively reviews the LVEF-improving effects of current pharmacological,device-based,and surgical interventions,along with monitoring and management strategies for HFimpEF patients.In HFrEF patients,clinical evidence suggests that β-blockers and cardiac resynchronization therapy can significantly improve LVEF beyond 40%.Regarding HFimpEF management,sodium-glucose cotransporter-2 inhibitors(SGLT2i)and renin-angiotensin system inhibitors(RASi)demonstrate efficacy in maintaining LVEF and cardiac function.Additionally,this review identifies current research limitations in HFimpEF and proposes potential future research directions.
