AIMS Although left ventricular ejection fraction (LVEF) is routinely used to categorize patients with heart failure (HF), whether it predicts outcomes after hospitalization for acute heart failure (AHF) is uncertain. Consequently, we assessed the relationship between LVEF and cardiovascular (CV) outcomes in a large, well characterized cohort of patients hospitalized for AHF. METHODS AND RESULTS The 6128 patients from the RELAX-AHF-2 trial who had LVEF measured during AHF hospitalization were separated into LVEF quartiles and the relationship between LVEF and a composite of CV mortality and rehospitalization for HF or renal failure through 180 days was assessed. We found progressively lower risk for this composite outcome as LVEF increased (hazard ratio 0.95, 95% confidence interval 0.93-0.98 per 5% LVEF increase, P < 0.001) that was driven predominantly by decreased risk for rehospitalization. The smoothed spline curve depicting risk remained stable as LVEF decreased until reaching approximately 40%, at which point risk increased progressively with further reductions in LVEF. Significant differences between LVEF quartiles for post-discharge CV risk were seen in patients with an ischaemic aetiology or with a history of HF preceding index hospitalization, but were less robust in patients with non-ischaemic aetiology and absent in those with de novo HF. CONCLUSION In patients hospitalized with AHF, CV events over 180 days were more frequent in patients with lower LVEF. This was due predominantly to a significant increase in risk for HF/renal failure rehospitalization but not in either CV or all-cause mortality. LVEF had greater prognostic value in patients with ischaemic aetiology or pre-existing HF.

中文翻译：

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心力衰竭住院后左心室射血分数与心血管结局的关系：RELAX-AHF-2试验的见解。

目的尽管常规使用左心室射血分数（LVEF）对心力衰竭（HF）的患者进行分类，但尚不确定是否可以预测住院后发生急性心力衰竭（AHF）的结果。因此，我们评估了一大批特征明确的AHF住院患者的LVEF与心血管（CV）结果之间的关系。方法和结果将RELAX-AHF-2试验的6128例在AHF住院期间进行LVEF测定的患者分为LVEF四分位数，评估LVEF与CV死亡率和HF或肾功能衰竭住院180天的复合住院之间的关系。我们发现随着LVEF的增加，该综合结果的风险逐渐降低（风险比0.95,95％置信区间0.93-0.98，每5％LVEF升高，P <0。001），主要是由于重新住院风险降低。平滑的样条曲线表示风险随着LVEF的降低而保持稳定，直至达到约40％，此时，随着LVEF的进一步降低，风险逐渐增加。LVEF四分位数之间的出院后CV风险之间存在显着差异，发生于缺血性病因或有HF指数住院之前有过病史的患者，但在非缺血性病因的患者中则没有那么强健，而从无HF的患者则没有。结论在AHF住院患者中，LVEF较低的患者发生180天以上的CV事件更为频繁。这主要是由于HF /肾衰竭再住院的风险显着增加，而不是CV或全因死亡率。