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Original Article
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Korean J Intern Med. 2026;41(3):474-484. Published online May 1, 2026.
DOI: https://doi.org/10.3904/kjim.2025.309
- Clinical outcomes of heart failure with improved ejection fraction in patients treated with angiotensin receptor–neprilysin inhibitor
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Dong-Eon Kim1, Min Gyu Kong1
, Saerom Kim1, Inki Moon1, Hyun Woo Park1, Hyung-Oh Choi1, Hye Sun Seo1, Yoon Haeng Cho1, Nae-Hee Lee1, Kwan Yong Lee2, Ho-Jun Jang3, Je Sang Kim4, Ik Jun Choi5, Jon Suh1
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1Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
2Cardiovascular Center and Division of Cardiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Division of Cardiology, Department of Internal Medicine, Hanil General Hospital, Seoul, Korea
4Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
5Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Corresponding author: Min Gyu Kong ,Tel: +82-32-621-6727, Email: mingyu.kong@schmc.ac.kr
- Received: September 7, 2025; Revised: November 29, 2025 Accepted: January 12, 2026.
- Abstract
- Background/Aims
Improvement of left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF) has been associated with favorable outcomes; however, corresponding data in patients treated with angiotensin receptor– neprilysin inhibitors (ARNIs) remain limited. This study aimed to examine the characteristics, predictors, and outcomes of HF with improved ejection fraction (HFimpEF) compared with persistent HFrEF in the RECORD-SV registry.
Methods
Patients with LVEF ≤ 40% in the RECORD-SV registry were classified based on echocardiographic assessments at baseline and 1-year follow-up. Patients with HFimpEF were defined as those with follow-up LVEF of > 40% with an absolute improvement of ≥ 10%, whereas the persistent HFrEF group included those who did not meet these criteria. Baseline characteristics, predictive factors, and clinical outcomes of the patients were analyzed. The primary composite outcome was allcause mortality and hospitalization for HF management, with secondary outcomes including each component of the primary outcome and frequency of urgent emergency room visits.
Results
Among 198 patients with HFrEF, 60 patients (30.3%) achieved HFimpEF after one year of ARNI-based therapy. Independent predictors of HFimpEF included female sex, non-ischemic etiology, and de novo HF. HFimpEF patients exhibited significantly lower risks in the primary composite outcome (HR 0.382, 95% CI 0.148–0.985) compared to those with persistent HFrEF, with a similar trend observed for secondary outcomes.
Conclusions
Patients achieving HFimpEF with ARNIs exhibited distinct clinical features and significantly lower risk of cardiovascular events compared to those with persistent HFrEF, highlighting the prognostic benefit of EF recovery with ARNI therapy.
Keywords :Heart failure; Ventricular remodeling; Neprilysin
