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HF with Recovered EF — EECC MCQ

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HardHeart FailureHF with Recovered EFEECC

A 58-year-old man with HFrEF (LVEF 25%) and LBBB (QRS 158 ms) undergoes CRT-D implantation. At 6-month follow-up, echocardiography shows LVEF has improved to 48% and LV end-diastolic diameter has reduced from 68 mm to 52 mm. He is now NYHA class I. NT-proBNP has normalised. He is on sacubitril/valsartan, bisoprolol, eplerenone, and dapagliflozin. What should be the approach to his GDMT?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Continue all medications at current doses indefinitely

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · C = shown as D

Recovery of LVEF does not mean the underlying myocardial disease has resolved. Per the 2021 ESC HF Guidelines, withdrawal of GDMT in patients with improved LVEF risks relapse and is associated with worse outcomes (TRED-HF trial). All four pillars should be continued at maximally tolerated doses. Stopping medications (A, D, E) is not recommended. Downgrading ARNI to ACEi (C) would remove the additional benefit of neprilysin inhibition.

Reference: ESC (2021): Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure