Heart failure with recovered ejection fraction: Current understanding and future prospects

In clinical practice, left ventricular ejection fraction (LVEF) is an important indicator to measure left ventricular systolic function. With the development of new drugs and device-based therapies, researchers have repeatedly identified that LVEF can be significantly improved in some patients with HF with reduced ejection fraction (HFrEF), whether treated or not. ^, Previous literature has reported the clinical features, pathophysiology, and prognosis of these patients with HF are different from those with HFrEF or preserved ejection fraction (HFpEF), suggesting that this type of HF may be a unique phenotype, defined as HF with recovered ejection fraction (HFrecEF). ^, Contemporary management of HF is mainly based on LVEF. However, due to insufficient attention to the recovery of LVEF in the past and a lack of understanding of its internal pathophysiological mechanism, an accurate and unified definition of HFrecEF has not yet been formed. More importantly, there may be large measurement variability in LVEF and LVEF alone may not reflect hemodynamic changes well,

further weakening the understanding of the HFrecEF subgroup from previous literature. All of these have made it difficult to recognize, evaluate, and treat these patients effectively.

This review will present the definition, epidemiological data, clinical characteristics, predictors of HFrEF recurrence, and prognosis of HFrecEF. Based on the limited data, the pathophysiological mechanism and the management strategy of drugs and devices are discussed, and the deficiencies and controversies of current research and further investigation are put forward.