Prognosis of patients with 20 percent ejection fraction
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Ejection Fraction 20 Percent: Prognostic Significance in Heart Failure
Prognostic Value of Severely Reduced Ejection Fraction
A left ventricular ejection fraction (EF) of 20% is considered severely reduced and is a strong indicator of poor prognosis in patients with heart failure. Studies consistently show that EF is one of the most powerful predictors of short-term and long-term survival in patients with heart failure and coronary artery disease. Patients with a severely reduced EF have significantly higher mortality rates compared to those with normal or mildly reduced EF, even when other risk factors are present 12.
Short-Term and Long-Term Outcomes
In patients with severe chronic heart failure and a mean EF around 20%, short-term outcomes are poor. One study found that during an average follow-up of about 11 months, nearly 29% of patients died and another 23% required heart transplantation. The overlap in left ventricular EF between survivors and non-survivors was substantial, but right ventricular ejection fraction was even more predictive of early death. Patients with right ventricular EF below 24% had significantly worse short-term survival .
Long-term, patients with heart failure and reduced EF (HFrEF) continue to have high mortality and hospitalization rates. Meta-analyses show that the prognosis for HFrEF is worse than for those with mid-range or preserved EF, with higher risks of death and heart failure-related hospitalizations 24. Five-year survival rates for patients with reduced EF are low, often below 50% .
Impact of Underlying Cause and Comorbidities
The underlying cause of heart failure, such as coronary artery disease (CAD) or idiopathic dilated cardiomyopathy (DCM), does not significantly change the poor prognosis associated with a severely reduced EF. One-year mortality rates are similar between these groups, though patients with idiopathic DCM may be more likely to receive a heart transplant . Other comorbidities, such as chronic kidney disease, diabetes, and higher New York Heart Association (NYHA) class, further worsen outcomes 610.
Prognosis with EF Improvement
Some patients with initially low EF can experience significant improvement with optimal medical therapy. Those whose EF improves have much better outcomes, with lower mortality and fewer hospitalizations compared to those whose EF remains persistently low 78. However, for patients whose EF remains at or near 20%, the risk of death and need for advanced therapies like transplantation remains high.
Conclusion
Patients with an ejection fraction of 20% face a high risk of mortality and adverse outcomes, both in the short and long term. EF is a critical prognostic marker, and severely reduced values signal the need for aggressive management and consideration of advanced therapies. Right ventricular function, comorbidities, and the potential for EF improvement also play important roles in determining prognosis. Overall, a 20% ejection fraction is associated with a poor outlook, underscoring the importance of close monitoring and comprehensive care in this population 12346789+1 MORE.
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