Heart failure with mid‐range ejection fraction: a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (<scp>TIME‐CHF</scp>)

Rickenbacher, Peter; Kaufmann, Beat A.; Maeder, Micha T.; Bernheim, Alain; Goetschalckx, Kaatje; Pfister, Otmar; Pfisterer, Matthias; Rocca, Hans‐Peter Brunner‐La; Investigators, Time-Chf

doi:10.1002/ejhf.798

Cited by 127 publications

(185 citation statements)

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“…Our findings are in line with those from Lam and Solomon, albeit in a much larger group of patients, suggesting patients with HFmrEF have heavy representation of risk factors for-or established-vascular disease. 17,18 Heart failure with preserved EF may also have unique characteristic physiological responses to exercise as well, and recently, a study by Pugliese and colleagues examined patients with HFrEF, HFmrEF, and HFpEF and demonstrated BMI, body mass index; b.p.m., beats per minute; CABG, coronary artery bypass graft; EF, ejection fraction; HF, heart failure; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; PCI, percutaneous intervention; PTCA, percutaneous transluminal coronary angioplasty; SD, standard deviation. In a 2007 analysis of 41 267 registry patients, characteristics of patients with LVEF between 40 and 50% were closer to those of patients with HFpEF.…”

Section: Discussionmentioning

confidence: 99%

Heart failure with mid‐range ejection fraction: characterization of patients from the PINNACLE Registry®

et al. 2019

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Aims Guidelines for management of patients with heart failure with mid‐range ejection fraction [HFmrEF; left ventricular EF (LVEF) 41–49%] do not exist. Disagreement exists whether HFmrEF should be considered a distinct group. The aim of this study is to examine characteristics of patients with HFmrEF with HF with reduced EF (HFrEF; LVEF ≤ 40%) or preserved EF (HFpEF; LVEF ≥ 50%). Methods and results We examined data collected in the American College of Cardiology's National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) Registry® for first HF patient visits between 1 May 2008 and 30 June 2016. Analysis was performed using ANOVA F‐tests (or Kruskal–Wallis tests for non‐normally distributed variables) for continuous parameters and χ2 tests for nominal covariates at the first diagnosed HF visit. Given the NCDR PINNACLE Registry® is a US‐based registry, we opted to define HFmrEF as per the US guidelines, which define HFmrEF as LVEF 41–49% in contrast to European guidelines, which define HFmrEF as LVEF 40–49%. Among 1 103 386 patients with available data, 36.1% (N = 398 228) had HFrEF, 7.5% (N = 82 292) had HFmrEF, and 56.5% (N = 622 866) had HFpEF. Compared with patients with HFrEF or HFpEF, patients with HFmrEF had more prevalent coronary and peripheral artery disease and more history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery (all P < 0.001). Patients with HFmrEF were also more likely to have atrial fibrillation/flutter, diabetes, and chronic kidney disease and to have a history of tobacco use (both P < 0.001). Among those with EF assessment prior to this analysis, only 4.8% (N = 1032) previously had HFrEF that improved to HFmrEF; 32.9% (N = 7072) had HFpEF previously and progressed to HFmrEF. Those patients who transitioned from HFpEF to HFmrEF had considerably more complex profiles and were less aggressively managed compared with those who remained with HFmrEF (all P < 0.001). Conclusions In this large descriptive analysis, patients with HFmrEF had an atherothrombotic phenotype distinct from other forms of HF. Interventions aimed at treating coronary ischaemia and addressing prevalent risk factors may play a particularly important role in the management of patients with HFmrEF.

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Section: Discussionmentioning

confidence: 99%

Heart failure with mid‐range ejection fraction: characterization of patients from the PINNACLE Registry®

et al. 2019

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“…[170][171][172][173][174][175][176] With Highlights in heart failure respect of outcomes, prognosis of the patients with HFmrEF is slightly better than that of the patients with HFrEF in most, but not all, 177 of the studies. a LVEF between 40% and 49% (HFmrEF).…”

Section: Heart Failure With Mid-range Ejection Fractionmentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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“…Although clinical entity of chronic HF with reduced LV ejection fraction (EF) < 40% (HFrEF) and preserved LVEF = 50-59% (HFpEF) respectively has defined, there is not completely clear whether HF (HFmrEF) related to mid-range LVEF=40-49% could associate with clinical outcomes and prognosis similar other phenotypes of chronic HF [6]. The analysis of the TIME-CHF (Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure) trail yielded that clinical status, profile of comorbidities including CAD and impaired quality of life of individuals with HFmrEF were comparable to patients with HFrEF, but these patients were not similar HFpEF in these fields [7]. In the Swedish Heart Failure Registry a higher adjusted risk of all-cause death and CV death in patients with HFmrEF and HFrEF versus HFpEF was defined [8].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, there is overlapping in clinical and biomarker-based prediction of outcomes in different HF phenotypes [9,10]. Indeed, natriuretic peptides (NPs) and cardiac troponins strongly predicted HFrEF and HFmrEF, but not HFpEF, although galectin-3 and soluble ST2 yielded much accurate predictive values for newly diagnosed HFpEF / HFmrEF and HFrEF-related admission to the hospital [7,9]. Recent clinical trial has shown that biomarker-guided therapy based on serial measure of N-terminal pro-B-type NP (NT-proBNP) in comparison with standard HF therapy resulted in improved survival free of chronic HF admissions in HFrEF and HFmrEF, but not in HFpEF [7].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, natriuretic peptides (NPs) and cardiac troponins strongly predicted HFrEF and HFmrEF, but not HFpEF, although galectin-3 and soluble ST2 yielded much accurate predictive values for newly diagnosed HFpEF / HFmrEF and HFrEF-related admission to the hospital [7,9]. Recent clinical trial has shown that biomarker-guided therapy based on serial measure of N-terminal pro-B-type NP (NT-proBNP) in comparison with standard HF therapy resulted in improved survival free of chronic HF admissions in HFrEF and HFmrEF, but not in HFpEF [7]. Therefore, there are several limitations regarding biomarkers' interpretation in chronic HF patients with older age, comorbidities and valsartan / sucubitrile use added to conventional HF therapy [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Cardiovascular Clinical Outcomes with Novel Biomarker: the Focus on Growth Differentiation Factor 15

2018

International Journal of Research Studies in Biosciences

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Heart failure with mid‐range ejection fraction: a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME‐CHF)

Cited by 127 publications

References 29 publications

Heart failure with mid‐range ejection fraction: characterization of patients from the PINNACLE Registry®

Heart failure with mid‐range ejection fraction: characterization of patients from the PINNACLE Registry®

Highlights in heart failure

Prediction of Cardiovascular Clinical Outcomes with Novel Biomarker: the Focus on Growth Differentiation Factor 15

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