Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Zhang, Xinxin; Sun, Yuxi; Chen, Feifei; Zhang, Shuyuan; He, Hui; Song, Shuang; Tse, Gary; Liu, Ying

doi:10.3389/fcvm.2021.697221

Cited by 12 publications

(15 citation statements)

References 38 publications

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“…Our results supported that the response to medical treatment in HFmrEF was more similar to patients with reduced LVEF and complement our previous analysis in different HF subpopulations. [13][14][15][16][17] Interestingly, in our study, the baseline left ventricular diameter and brain natriuretic peptide level in TT group were higher than that of NTT group, indicating more severe HF in the TT group. It was possible that cardiologists considered patients with greater severity of illness, where the GDMT may be more appropriate.…”

Section: Discussioncontrasting

confidence: 44%

Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

et al. 2022

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Aims Heart failure with mildly reduced ejection fraction (HFmrEF) has received increasing attention following the publication of the latest ESC guidelines in 2021. However, it remains unclear whether patients with HFmrEF could benefit from guideline-directed medical treatment (GDMT), referring the combination of ACEI/ARB/ARNI, β-blockers, and MRAs, which are recommended for those with reduced ejection fraction. This study explored the efficacy of GDMT in HFmrEF patients. Methods This was a retrospective cohort study of HFmrEF patients admitted to The First Affiliated Hospital of Dalian Medical University between 1 September 2015 and 30 November 2019. Propensity score matching (1:2) between patients receiving triple-drug therapy (TT) and non-triple therapy (NTT) based on age and sex was performed. The primary outcome was all cause death, cardiac death, rehospitalization from any cause, and rehospitalization due to worsening heart failure. Results Of the 906 patients enrolled in the matched cohort (TT group, n = 302; NTT group, N = 604), 653 (72.08%) were male, and mean age was 61.1 ± 11.92. Survival analysis suggested that TT group experienced a significantly lower incidence of prespecified primary endpoints than NTT group. Multivariable Cox regression showed that TT group had a lower risk of all-cause mortality (HR 0.656, 95% CI 0.447-0.961, P = 0.030), cardiac death (HR 0.599, 95% CI 0.380-0.946, P = 0.028), any-cause rehospitalization (HR 0.687, 95% CI 0.541-0.872, P = 0.002), and heart failure rehospitalization (HR 0.732, 95% CI 0.565-0.948, P = 0.018). Conclusions In patients with HFmrEF, combined use of neurohormonal antagonists produces remarkable effects in reducing the occurrence of the primary outcome of rehospitalization and death. Thus, the treatment of HFmrEF should be categorized as HFrEF due to the similar benefit of neurohormonal blocking therapy in HFrEF and HFmrEF.

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Section: Discussioncontrasting

confidence: 44%

Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

et al. 2022

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“…A number of factors could affect the prognosis of HFpEF (37)(38)(39)(40)(41). LV diastolic dysfunction plays a central role in the pathophysiology of HFpEF, defined as an impairment in relaxation or an increase in stiffness.…”

Section: Comorbidities and Prognostic Factors In Hfpefmentioning

confidence: 99%

Predictive Value of HFA-PEFF Score in Patients With Heart Failure With Preserved Ejection Fraction

Sun

et al. 2021

Front. Cardiovasc. Med.

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Aims: HFA-PEFF score has been proposed for diagnosing heart failure with preserved ejection fraction (HFpEF). Currently, there are only a limited number of tools for predicting the prognosis. In this study, we evaluated whether the HFA-PEFF score can predict mortality in patients with HFpEF.Methods: This single-center, retrospective observational study enrolled patients diagnosed with HFpEF at the First Affiliated Hospital of Dalian Medical University between January 1, 2015, and April 30, 2018. The subjects were divided according to their HFA-PEFF score into low (0–2 points), intermediate (3–4 points), and high (5–6 points) score groups. The primary outcome was all-cause mortality.Results: A total of 358 patients (mean age: 70.21 ± 8.64 years, 58.1% female) were included. Of these, 63 (17.6%), 156 (43.6%), and 139 (38.8%) were classified into the low, intermediate, and high score groups, respectively. Over a mean follow-up of 26.9 months, 46 patients (12.8%) died. The percentage of patients who died in the low, intermediate, and high score groups were 1 (1.6%), 18 (11.5%), and 27 (19.4%), respectively. A multivariate Cox regression identified HFA-PEFF score as an independent predictor of all-cause mortality [hazard ratio (HR):1.314, 95% CI: 1.013–1.705, P = 0.039]. A Cox analysis demonstrated a significantly higher rate of mortality in the intermediate (HR: 4.912, 95% CI 1.154–20.907, P = 0.031) and high score groups (HR: 5.291, 95% CI: 1.239–22.593, P = 0.024) than the low score group. A receiver operating characteristic (ROC) analysis indicated that the HFA-PEFF score can effectively predict all-cause mortality after adjusting for age and New York Heart Association (NYHA) class [area under the curve (AUC) 0.726, 95% CI 0.651–0.800, P = 0.000]. With an HFA-PEFF score cut-off value of 3.5, the sensitivity and specificity were 78.3 and 54.8%, respectively. The AUC on ROC analysis for the biomarker component of the score was similar to that of the total score.Conclusions: The HFA-PEFF score can be used both to diagnose HFpEF and predict the prognosis. The higher scores are associated with higher all-cause mortality.

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“…According to prior studies, HFmrEF significantly affects the patient outcome, and the mortality as well as the rate of adverse events are intermediate between heart failure with preserved and reduced EF (20)(21)(22)(23). Furthermore, other studies report that HFmrEF is composed of three subsets, including deteriorated, stable and improved (according to the prior EF level), and the prognosis of these three groups of patients were differed (9,24), indicating that the improvement of EF is crucial to the improvement of patient outcome. There is also evidence on the impact of HFmrEF in patients receiving coronary artery bypass grafting, suggesting that HFmrEF negatively impacts patient outcomes including survival, myocardial infarction and hospitalization for heart failure (12).…”

Section: Discussionmentioning

confidence: 99%

“…According to previous studies, the prevalence of HFmrEF among patients ranges from 13% to 26% ( 6 - 9 ), and it shows important influence on the prognosis of the patients. He et al reports in their study that HFmrEF increases the risk of deterioration of cardiac function after permanent pacemaker implantation ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of patients with aortic valve disease complicated with moderate functional mitral regurgitation and heart failure with midrange ejection fraction: a cohort study

Zhao¹,

Tiemuerniyazi²,

Song³

et al. 2022

J Thorac Dis

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Background: Controversies exist on the treatment of moderate functional mitral regurgitation (FMR) in patients with severe aortic valve disease undergoing the aortic valve replacement (AVR). While a substantial proportion of these patients can be complicated with heart failure with midrange ejection fraction (HFmrEF), established studies show that the latter might compromise the patient outcome. This study was aimed to evaluate the prognostic value of concomitant mitral valve surgery during AVR in patients with severe aortic valve disease followed by moderate FMR and HFmrEF.Methods: A total of 78 consecutive patients were retrospectively recruited. Patients were divided into control (isolated AVR) and treatment (AVR + mitral valve surgery) groups. Follow-up outcomes were compared by Kaplan-Meier method, followed by multiple adjustment with inverse probability treatment weighting (IPTW) analysis. The primary outcome was the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE).Results: Thirty-six patients received isolated AVR, while 42 received AVR with mitral valve repair or replacement. The median follow-up time was 28.7 months. Unadjusted analysis showed that there was no significant difference in the rate of MACCE between the two groups [hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.48-2.69, P logrank =0.770], which was sustained in IPTW analysis [HR: 1.64, 95% CI: 0.59-4.55, P logrank =0.342]. In addition, while concomitant mitral valve surgery improved follow-up FMR more completely (P=0.026) in the IPTW analysis, the ejection fraction was comparable between the two groups (P=0.276). Furthermore, IPTW analysis also showed that mitral valve surgery was associated with the increased risk of postoperative acute kidney injury (P=0.007). Conclusions:In patients with aortic valve disease followed by moderate FMR and HFmrEF, mitral valve surgery concomitant to AVR may not bring extra benefit in the MACCE-free survival and the improvement of HFmrEF. However, while concomitant mitral valve surgery has priority on the complete improvement of FMR, it might increase the risk of postoperative acute kidney injury.

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Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Cited by 12 publications

References 38 publications

Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

Predictive Value of HFA-PEFF Score in Patients With Heart Failure With Preserved Ejection Fraction

Surgical treatment of patients with aortic valve disease complicated with moderate functional mitral regurgitation and heart failure with midrange ejection fraction: a cohort study

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