Impaired myocardial work in heart failure with improved ejection fraction: A post hoc analysis from the CATHEDRAL-HF trial.

BACKGROUND

Myocardial Work (MW) is a novel echocardiographic tool to assess left ventricular (LV) function. Data on MW in patients with heart failure with improved ejection fraction (HFimpEF) are scarce, and this study aims to describe and compare MW in patients with HFimpEF at baseline and after suspending heart failure (HF) treatment, maintaining carvedilol.

METHODS

Carvedilol as a single maintenance therapy for heart failure with improved ejection fraction (CATHEDRAL-HF) was a randomized clinical trial comparing usual HF treatment (control group) versus suspension of HF treatment, maintaining carvedilol (intervention group), in patients with HFimpEF and LV ejection fraction (LVEF) ≥50 % plus NT-proBNP<250 g/mL. We evaluated MW components at baseline and 24-week follow-up and compared values between groups.

RESULTS

Between May 20, 2022, and February 10, 2023, 60 patients were enrolled and randomized 1:1, 53.3 % men. Fifty-three patients completed follow-up and we obtained MW evaluation of 59 patients at baseline and 48 patients at 24 weeks. Median LVEF at randomization was 59 % (IQR 54-63). Patients had increased Global Work Waste with reduced Global Work Index, Global Constructive Work and Global Work Efficiency in both groups compared to normal range, but they were similar between groups. At 24 weeks, MW components did not change and remained similar between groups.

CONCLUSIONS

Suspension of HF treatment maintaining carvedilol did not alter MW components in HFimpEF. However, patients had altered MW components compared to normal range, even with normal LVEF, suggesting LV dysfunction persists in this population despite normal LVEF.