{"id":"25ddd38c9d84","type":"article","url":"https://hartvaat.nl/2026/10/13/quadrupel-therapie-bij-hfref-veel-lvef-hervatting-en-minder-vaak-een-defibrillat/","title":"Quadrupel therapie bij HFrEF: veel LVEF-hervatting en minder vaak een defibrillator nodig","title_en":"Left ventricular ejection fraction recovery under contemporary quadruple guideline-directed therapy and the need for ICD/CRT-D implantation in HFrEF: a retrospective single-center cohort study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Expert review of cardiovascular therapy","doi":"10.1080/14779072.2026.2748165","source_url":"https://doi.org/10.1080/14779072.2026.2748165","authors":["Issameddine Ajmi","Mathis Philipp Frings","Mathias Forkmann","Christian Mahnkopf"],"significance":4,"published":"2026-10-21","source_date":"2026-10-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"A retrospective single-center cohort study (n=65) demonstrates that patients with HFrEF on contemporary quadruple guideline-directed medical therapy frequently experience significant LVEF recovery, primarily without requiring ICD or CRT-D implantation. LVEF improved from 28.0% to 36.0% on echocardiography and from 26.3% to 38.5% on CMR, with larger baseline left ventricular end-diastolic diameter predicting less recovery and higher device implantation rates. These findings reinforce guideline recommendations to defer device therapy for at least three months on optimal medical treatment, though the small sample size and lack of arrhythmic outcome data warrant cautious interpretation.","created":"2026-10-14T01:33:04Z","updated":"2026-10-14T01:33:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectieve single-center studie (n=65) toont aan dat patiënten met HFrEF onder quadrupel richtlijntherapie (beta-blokker, ARNI, MRA en SGLT2-remmer) vaak een significante verbetering van de LVEF ervaren, voornamelijk zonder implantatie van een ICD of CRT-D. De gemiddelde LVEF steeg van 28,0% naar 36,0% (TTE) en van 26,3% naar 38,5% (CMR), terwijl een grotere begin-diameter van de linkerhartkamer correleerde met minder hervatting en een hogere kans op device-implantatie. Deze bevindingen ondersteunen het richtlijnadvies om device-implantatie uit te stellen tot na drie maanden optimale medicatie, maar de beperkte steekproef en ontbrekende gegevens over dosering en aritmie maken generalisatie vooralsnog voorzichtig.","abstract_original":"BACKGROUND: Guidelines advise deferring primary-prevention implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) implantation until left ventricular ejection fraction (LVEF) is reassessed after at least three months of medical therapy in heart failure with reduced ejection fraction (HFrEF). Real-world data under contemporary quadruple therapy are limited. RESEARCH DESIGN AND METHODS: Retrospective single-center cohort of 65 HFrEF patients (Coburg Hospital, Germany; October 2023-December 2024), prescribed beta-blocker, angiotensin receptor-neprilysin inhibitor, mineralocorticoid receptor antagonist and SGLT2 inhibitor (all four in 92%; doses not recorded). LVEF was measured by echocardiography (TTE) and cardiac magnetic resonance (CMR) at baseline and ~3 months; reader blinding was not documented. Device implantation followed guideline criteria. Patients with severe arrhythmic events were excluded. RESULTS: Twenty-nine patients (44.6%) received a device. LVEF rose on TTE (28.0→36.0%) and CMR (26.3→38.5%) (both p < 0.001), mainly without device implantation (TTE +13.0 vs + 1.5 points). Larger baseline left ventricular end-diastolic diameter was associated with smaller recovery (β = -0.41, p = 0.006) and device implantation (odds ratio 1.11/mm, 95% CI 1.01-1.22). Adverse events were not recorded. CONCLUSIONS: LVEF recovery was common, and associations are consistent with disease severity. Findings are hypothesis-generating; absent dose, arrhythmic-outcome and wearable-defibrillator data and the selected cohort limit generalizability."}