by Prateek Chopra | May 22, 2026 | Cardiology Conferences | ESC-HF 2026
Heart failure with improved ejection fraction (HFimpEF) is increasingly recognized as a clinically meaningful phenotype in patients with heart failure with reduced ejection fraction (HFrEF). However, the factors associated with improvement in left ventricular ejection fraction (LVEF) remain incompletely understood. This study aimed to identify predictors associated with HFimpEF in patients with chronic HFrEF. The findings were presented at Heart Failure 2026, organized by the European Society of Cardiology, held in Barcelona, Spain, from 9–12 May 2026.
A single-center retrospective study included consecutive patients with chronic HFrEF followed at a heart failure clinic between 2014 and 2024. Clinical characteristics, biomarkers, electrocardiographic and echocardiographic findings, previous diseases, and medication use were recorded. HFimpEF, defined as LVEF ≥40% with an improvement of ≥10% from baseline at one year, was the primary endpoint. Backward Wald logistic regression was used to identify independent predictors of HFimpEF.
A total of 292 patients were included, of whom 73.3% were male, with a mean age of 59.9±11.8 years. Ischemic etiology was present in 35.3%, and mean baseline LVEF was 25.0±10.2%. HFimpEF occurred in 24.0% of patients. HFimpEF was more frequent among smokers, patients with atrial fibrillation, non-ischemic etiology, absence of coronary artery disease (CAD), shorter QRS duration, absence of late gadolinium enhancement (LGE), and those receiving SGLT2 inhibitors at baseline. Logistic regression analysis demonstrated very good predictive accuracy for HFimpEF (AUC=0.835). Previous CAD, ischemic-pattern LGE, and longer QRS duration were identified as independent negative predictors of HFimpEF, whereas smoking paradoxically emerged as the strongest predictor.
Previous CAD, ischemic-pattern LGE, and QRS duration were independent predictors of HFimpEF. The unexpected association between smoking and HFimpEF warrants further investigation.