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Heart failure with reduced ejection fraction — RACP Adult Medicine MCQ

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HardCardiologyHeart failure with reduced ejection fractionRACP Adult Medicine

A 64-year-old man is admitted with worsening breathlessness, raised JVP and pulmonary oedema. Echocardiography shows LVEF 28%, moderate functional mitral regurgitation and no severe valve lesion. NT-proBNP is markedly elevated and eGFR is 48 mL/min/1.73 m2. What is the most important prognostic factor?

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Correct answer: D — Left ventricular systolic function and neurohormonal activation

Reduced ejection fraction and high natriuretic peptide levels are powerful markers of prognosis in heart failure. Peripheral oedema and diuretic use reflect congestion but are less robust prognostic markers than ventricular dysfunction and neurohormonal activation. Normal potassium and absence of pleuritic pain do not determine long-term heart failure risk.

Reference: National Heart Foundation of Australia Heart Failure Guidelines; AMH