Clinical, Echocardiographic, and Therapeutic Characteristics of Heart Failure in Patients with Preserved, Mid-Range, and Reduced Ejection Fraction: Future Directions

Abstract

Background Heart failure (HF) is recognized as a worldwide epidemic. Definitions and risk stratification are usually based upon measurements of left ventricular ejection fraction (LVEF) but such classifications reflect an underlying spectrum of different pathologic, phenotypic, and therapeutic patterns. Methods This was a retrospective cohort study of HF patients in Saudi Arabia. Patients were divided into three categories based on LVEF: those with preserved ejection fraction (EF) (EF≥50%, HFpEF); those with mid-range EF (EF 40–49%, HFmrEF); and those with reduced EF (EF <40%, HFrEF). Their demographics, co-morbid conditions, echocardiographic findings, pharmacological treatments and all-cause mortality (ACS) after a follow-up period of 24 months were compared. Results A total of 293 HF patients were identified (mean age: 63 years). In total, 65% were males, 79% were Saudi nationals, and 70% had type 2 diabetes mellitus (DM). Classification based on EF was established in 288 patients: HFpEF (105 patients, 36.5%), HFmrEF (49, 17.0%), and HFrEF (134, 46.5%). The 3 groups differed in sex distribution: 51% females in the HFpEF group and 78% males in the HFrEF group (P<0.001). Body mass index (BMI) was highest in the HFpEF group and lowest in the HFrEF group (31.5 vs 26.6; P<0.001). Although systolic blood pressure (SBP in mmHg) was highest in patients with HFpEF, left ventricular mass index (LVMI in g/cm 2 ) was highest in patients with HFrEF 121.00 (94.50, 151.50), and eccentric hypertrophy was the dominant LV geometrical characteristic (54.6%). HFrEF patients had the highest use of ACE inhibitors (60.5%), loop diuretics (79.9%), and aldosterone receptor antagonists (56.7%) (P values; 0.009, 0.007, and <0.001, respectively). A total of 42 deaths occurred during follow-up: HFpEF (17 events), HFmrEF (3 events) and HFrEF (22 events) (Logrank test P=0.189). Conclusion This Saudi HF population shows similarities to other populations: EF category distribution, sex distribution, therapeutic trends, and survival outcomes. However, findings related to the underlying risk factors, namely type 2 DM and obesity, have identified HFpEF as an emerging threat in this (relatively) young population.

Hemodynamic profile changes in reaction to nitroglycerin in patients with heart failure with mildly reduced ejection fraction: A pilot study

“…Our study confirms the intermediate character of HFmrEF patients' clinical profile, which is widely described in the literature [6][7][8][9]. The hemodynamic profile of all three groups shared the same characteristics at rest with significant differences exclusively in STR and PEP between HFmrEF and HFrEF patients.…”

Demographics and Characteristics of Acutely Decompensated Heart Failure (ADHF) Patients in a Tertiary Care Center in Saudi Arabia

“…Moreover, in a retrospective cohort study on HF patients in the Eastern region of Saudi Arabia, the majority of HF patients were males, and the mean age was 63 years. The most common comorbidities were hypertension and diabetes mellitus as well [ 15 ]. A variety of factors could contribute to this result but mainly it could be explained by the fact that males generally are more prone to cardiac disease as the cardioprotective effect estrogen has on females is well understood.…”

“…Another study that included patients from four centers in Riyadh and Buraida similarly reported that the majority of patients were males and that hypertension and diabetes mellitus were the most frequent comorbidities [ 14 ]. Moreover, in a retrospective cohort study on HF patients in the Eastern region, the majority of HF patients were males [ 15 ]. The most common comorbidities were hypertension and diabetes mellitus in the three studies mentioned [ 13 - 15 ].…”

“…Moreover, in a retrospective cohort study on HF patients in the Eastern region, the majority of HF patients were males [15]. The most common comorbidities were hypertension and diabetes mellitus in the three studies mentioned [13][14][15]. The previously mentioned studies reported demographic, clinical, echocardiographic, and therapeutic characteristics of chronic HF patients admitted to wards or visiting outpatient clinics.…”