Heart failure with mid‐range ejection fraction: pro and cons of the new classification of Heart Failure by European Society of Cardiology guidelines

Abstract

Currently, the assessment of left ventricular ejection fraction (LVEF) is the cornerstone of the classification of patients with heart failure (HF). The mid-range LVEF (HFmrEF) category was identified in an attempt to uncover specific characteristics of these patients. So far, the analysis of trials, registries, and observational studies have demonstrated that patients with midrange LVEF belong to a patient cohort with generally intermediate clinical profile as compared with other groups but with a remarkable variety of intrinsic phenotypes. This is due to the limitations of LVEF as the sole criterion to categorize patients with HF and characterize their prognosis, above all when it is >40%. To better define the HFmrEF phenotype, it is reasonable to consider other parameters, such as LVEF changes over time, HF aetiology, co-morbidities, and other imaging parameters. A multiparametric evaluation may contextualize a patient with HFmrEF in a more defined phenotype with a specific prognosis.

AT1 receptor blocker, but not an ACE inhibitor, prevents kidneys from hypoperfusion during congestive heart failure in normotensive and hypertensive rats

“…An enormous rise in the prevalence of heart failure (HF) is causing a tremendous burden on healthcare systems worldwide, and HF is now considered as a global pandemic 1 . Currently, HF can be divided into heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF) and somewhat controversial heart failure with mid-range ejection fraction (HFmrEF) 2 . This division is based on the left ventricular ejection fraction (LVEF), while patients with LVEF < 40% are classified to have HFrEF, patients with LVEF 40–49% HFmrEF and patient with LVEF ≥ 50% HFpEF.…”

Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia

“…Для подтверждения ХСНпФВ и ХСНсФВ требуются дополнительные критерии -структурно-функциональные изменения миокарда при ЭхоКГ и повышение НУП. Следует отметить, что недавние исследования особенностей и эффектов медикаментозной терапии при ХСНпФВ свидетельствуют о сходстве данного фенотипа СН с ХСНнФВ, что может предопределять изменение терминологии с ХСН с промежуточной на умеренно сниженную ФВ [13][14][15], но главное -подчеркивает ожидаемое улучшение исходов в данной группе, аналогичное группе ХСНнФВ.…”

Sacubitril/valsartan Inhibits Obesity-associated Diastolic Dysfunction through Suppression of Ventricular-vascular Stiffness

“…Heart failure (HF) with normal or preserved ejection fraction (HFpEF) represents a unique pathophysiological phenotype which is distinct from HF with reduced ejection fraction (HFrEF) [1]. It is associated with structural and functional abnormalities in the heart, characterized by an EF of more than 50% [2]. In this regard, asymptomatic diastolic dysfunction (or preclinical DD) is one of the earliest manifestations during the progression of HFpEF in obesity-associated heart disease in both adults and children [3][4][5].…”

“…2 and with a p-value ≤ 0.05 are shown. Statistical significance between the indicated groups determined by unpaired two-tailed t-tests.…”