AIMS    

Recent results regarding novel heart failure (HF) drugs suggest that systolic ejection time (SET) may be a promising therapeutic target with impact on prognosis. We evaluated determinants of SET in patients with acute heart failure (AHF) and assessed the prognostic utility of SET in AHF patients with reduced and preserved left ventricular ejection fraction (LVEF).

METHODS and RESULTS

We included consecutive patients with AHF admitted to our center, who also had serial echocardiograms at admission and prior to discharge (n=139, 37% women, mean age 73±11 years). To account for the collinearity of SET with heart rate (r=–0.687; p<0,001) and the fact that lower heart rate indicates better prognosis in HF, we calculated heart rate corrected SETc (using the Fridericia formula: SET/3√RR interval).

In AHF patients with LVEF<40% (n=52, 39%), SETc was 269 ±35ms at admission and increased significantly with recompensation (median +9 [quartiles 1;17] ms). This increase was associated with lower 6-month mortality risk (HR per 1 ms increment 0.98, 95%CI 0.95–1.00) and the combined end-point death/rehospitalization (HR per 1 ms increment 0.99, 0.98–1.00). In AHF patients with LVEF≥40% (n=80, 61%), SETc was 313 ±34 ms at admission, remained unchanged during hospitalization (D SETc = 0 [-7;7]), and longer SETc was associated with higher 6-month risk regarding the combined end-point (HR per 1 ms increment 1.01, 1.00–1.02).

CONCLUSION

In patients hospitalized for AHF, a longer duration of SETc, which accounts for HR, indicated a better 6-month prognosis in HFrEF, but worse prognosis in the non-HFrEF phenotype. Data suggest, that prolongation of SETc, i.e. by respective pharmacotherapy, might emerge as a novel treatment target for HF patients with LVEF<40%.

Figure: Change in heart rate corrected systolic ejection time [SETc] from admission to discharge according to left ventricular ejection fraction (LVEF) at discharge, in n=139 patients admitted to the hospital for acute heart failure (AHF)