Treatment with sildenafil did not reduce pulmonary artery pressures and did not improve other invasive haemodynamic or clinical parameters in our study population, characterized by HFpEF patients with predominantly isolated post-capillary pulmonary hypertension. (ClinicalTrials.gov, number NCT01726049).

Only a small number of studies validated the use of echocardiographic parameters at rest in patients with HFpEF. The best established parameter appears to be E/e', but the existing data only show modest correlations of E/e' with invasive filling pressures and outcomes in HFpEF.

Summary Background and objectives The hemodialysis procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the prevalence, time course, and associated patient- and dialysis-related factors of this entity and its association with outcome. Design, setting, participants, & measurements Hemodialysis patients (105) on a three times per week dialysis schedule were studied between March of 2009 and March of 2010. Echocardiography was performed before dialysis, at 60 and 180 minutes intradialysis, and at 30 minutes postdialysis. Hemodialysis-induced regional left ventricular systolic dysfunction was defined as an increase in wall motion score in more than or equal to two segments. Results Hemodialysis-induced regional left ventricular systolic dysfunction occurred in 29 (27%) patients; 17 patients developed regional left ventricular systolic dysfunction 60 minutes after onset of dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more often male, had higher left ventricular mass index, and had worse predialysis left ventricular systolic function (left ventricular ejection fraction). The course of blood volume, BP, heart rate, electrolytes, and acid–base parameters during dialysis did not differ significantly between the two groups. Patients with hemodialysis-induced regional left ventricular systolic dysfunction had a significantly higher mortality after correction for age, sex, dialysis vintage, diabetes, cardiovascular history, ultrafiltration volume, left ventricular mass index, and predialysis wall motion score index. Conclusions Hemodialysis induces regional wall motion abnormalities in a significant proportion of patients, and these changes are independently associated with increased mortality. Hemodialysis-induced regional left ventricular systolic dysfunction occurs early during hemodialysis and is not related to changes in blood volume, electrolytes, and acid–base parameters.

The 2016 European Society of Cardiology heart failure guidelines introduced the term 'heart failure with mid-range ejection fraction' (HFmrEF) to refer to patients with heart failure and a mildly reduced ejection fraction of 40-49%. About 20% of heart failure patients fall in this category. One of the main reasons for the introduction of this category was to stimulate research into this grey area. This review aims to highlight the key findings that have been published so far. Firstly, HFmrEF more closely resembles heart failure with reduced (HFrEF) than preserved ejection fraction (HFpEF) with regard to ischaemic aetiology, which is more frequent in both HFmrEF and HFrEF compared to HFpEF. Secondly, changes in ejection fraction over time are common, and seem to be more important than baseline ejection fraction alone. Patients who progress from HFmrEF to HFrEF have a worse prognosis than those who remain stable or transition to HFpEF. Lastly, and perhaps most importantly, retrospective analyses from a randomized trial suggest that patients with HFmrEF seem to benefit from therapies that have shown to improve outcome in HFrEF, whereas no such benefit was seen in patients with HFpEF.