INTRODUCTION The long-term evolution of clinical, echocardiographic and laboratory parameters of cardiac function in patients with chronic heart failure (HF) with either reduced (HFrEF) or mildly reduced (HFmrEF) left ventricular ejection fraction (LVEF) is incompletely characterized. METHODS We identified patients with chronic stable HF who presented at least twice to a university HF outpatient clinic between 1995 and 2021. Trajectories of NYHA functional class, LVEF, left ventricular internal enddiastolic diameter (LVIDD), NT-proBNP concentrations and HF treatment over ten years follow-up were analysed using fractional polynomials. Analyses were repeated after stratifying patients according to aetiology (ischemic vs. dilated) or HF category (HFrEF vs. HFmrEF). RESULTS A total of 2,132 patients were included, of whom 51% had ischemic and 49% had dilated HF. 86% and 14% were classified as HFrEF and HFmrEF, respectively. Mean LVEF was 28±10%, and median NT-proBNP and eGFR values were 1,170 (385-3,176) pmol/L and 81 (62-100) ml/min/1.73m², respectively. Median follow-up was 5.2 (2.6-9.2) years. Overall, NYHA functional class and LVIDD trajectories were U-shaped, whereas LVEF and NT-proBNP concentrations markedly improved during the first year and remained stable thereafter. However, the evolution of HF parameters significantly differed with respect to HF category and aetiology, with greater improvements seen in patients with HFrEF of non-ischemic origin. Improvements in HF variables were associated with optimization of HF therapy, notably with initiation and up-titration of renin-angiotensin-system blockers. DISCUSSION/CONCLUSION This study provides insights into the natural history of HF in a large cohort of well-treated chronic HF outpatients with respect to subgroups of HF and different etiologist.

中文翻译：

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扩张型或缺血性心肌病慢性心力衰竭患者的生物标志物、功能和超声心动图参数的长期轨迹。

引言 左心室射血分数（LVEF）降低（HFrEF）或轻度降低（HFmrEF）的慢性心力衰竭（HF）患者心功能的临床、超声心动图和实验室参数的长期演变尚未完全表征。方法 我们确定了 1995 年至 2021 年间至少两次到大学心力衰竭门诊就诊的慢性稳定性心力衰竭患者。NYHA 功能分级、左室射血分数 (LVEF)、左心室舒张末期内径 (LVIDD)、NT-proBNP 浓度和 10 次以上心力衰竭治疗的轨迹使用分数多项式对随访年数进行分析。根据病因（缺血性与扩张性）或 HF 类别（HFrEF 与 HFmrEF）对患者进行分层后重复分析。结果 总共纳入 2,132 名患者，其中 51% 患有缺血性症状，49% 患有扩张性心力衰竭。86% 和 14% 分别被归类为 HFrEF 和 HFmrEF。平均 LVEF 为 28±10%，NT-proBNP 和 eGFR 中值分别为 1,170 (385-3,176) pmol/L 和 81 (62-100) ml/min/1.73m²。中位随访时间为 5.2 (2.6-9.2) 年。总体而言，NYHA 功能分级和 LVIDD 轨迹呈 U 形，而 LVEF 和 NT-proBNP 浓度在第一年显着改善，此后保持稳定。然而，心力衰竭参数的演变在心力衰竭类别和病因方面存在显着差异，非缺血性 HFrEF 患者的改善更大。心力衰竭变量的改善与心力衰竭治疗的优化相关，特别是与肾素血管紧张素系统阻滞剂的启动和增量调整有关。讨论/结论 这项研究提供了对大量接受良好治疗的慢性心力衰竭门诊患者的心力衰竭自然史的见解，涉及心力衰竭亚组和不同病因。