Survival in Patients with Non-Ischemic Cardiomyopathy with Preserved versus Reduced Ejection Fraction

ABSTRACT Background Prior studies suggest similar long-term mortality between patients with heart failure (HF) with preserved (HFpEF) and reduced ejection fraction (HFrEF). However, while coronary heart disease (CHD) is associated with worse prognosis in HF, clinical outcomes are less well characterized for HF without CHD. We investigated the characteristics and 5-year mortality outcomes among patients with HF without significant CHD, stratified by EF. Methods Patients with clinical heart failure who underwent coronary angiography at Duke from 1996 to 2009 and had no significant CHD with EF ≤ 40% were compared with patients without significant CHD with EF > 40%. Survival was examined using Kaplan-Meier methods and multivariable Cox proportional hazards modeling. Analyses were repeated using EF ≥50%. Results Of 3154 patients with HF without significant CHD, 1530 (48.5%) had HFpEF (EF > 40%). These patients were older and more likely to have Charlson Index ≥2 than patients with reduced EF. Patients with HFpEF had lower risk of death than those with reduced EF (unadjusted hazard ratio [HR] 0.85; 95% CI 0.74-0.99). From 1996 to 2009, the secular trend of death decreased among patients without CHD and reduced EF (HR 0.92; 95% CI 0.88-0.97) but not among those with preserved EF (HR 0.99; 95% CI 0.93-1.05; p interaction 0.095). No finding was significant after multivariable risk adjustment. Results were consistent when defining preserved EF as EF ≥50%. Conclusions Among patients without significant CHD, those with HFpEF had similar risks of 5-year mortality as patients with HFrEF.