Left ventricular ejection fraction and heart failure: an indissoluble marriage?

Mele, Donato; Nardozza, Marianna; Ferrari, Roberto

doi:10.1002/ejhf.1071

Cited by 58 publications

(47 citation statements)

References 19 publications

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“…The current LVEF‐based HF classification does not take into account the underlying HF aetiology and its influence on prognosis . Cardiac magnetic resonance (CMR) imaging and late gadolinium enhancement add notable diagnostic and prognostic information in patients with HF, especially in the diagnostic workup of LV hypertrophy.…”

Section: Left Ventricular Ejection Fraction Based Classification: Oppmentioning

confidence: 99%

“…Finally, the epicardial fat detected by CMR is reduced in the HFrEF and increased in the HFmrEF and HFpEF populations compared with healthy controls, suggesting a possible role of fat‐associated inflammation in the mechanisms of HF in the upper value of the LVEF spectrum . Given that LVEF is an imaging‐based parameter, it is unable to fully account for the disease trajectory, including predisposition to malignant arrhythmias and the risk of sudden cardiac death . Nowadays, it is clear that a better stratification of the arrhythmic risk requires genetic testing, especially in dilated cardiomyopathy.…”

Section: Left Ventricular Ejection Fraction Based Classification: Oppmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Left Ventricular Ejection Fraction Based Classification: Oppmentioning

confidence: 99%

Section: Left Ventricular Ejection Fraction Based Classification: Oppmentioning

confidence: 99%

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

et al. 2020

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“…61,62 However, LVEF is influenced by hemodynamic loading conditions and has low sensitivity for detecting incipient changes. 63 Moreover, different studies used different techniques to measure myocardial contractility (eg, left ventricular systolic time interval ratio or left ventricular pre-ejection period in impedance cardiography), further confounding efforts to compare results. 65 Some studies suggest that the main cause of the decrease in left ventricular contractility is anemia rather than iron deficiency, as LVEF does not change in patients with iron deficiency without anemia, 59 although the results of these studies might also be affected by the same bias.…”

Section: Systolic Functionmentioning

confidence: 99%

Anemia and iron deficiency in heart failure: a review of echocardiographic features

2019

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Anemia and iron deficiency are often associated with heart failure, influencing the symptoms and prognosis. Correction of anemia and iron deficiency improves functional capacity and decreases hospitalizations. Many studies have analyzed echocardiographic parameters in iron deficiency and anemia and their evolution after iron treatment; however, the heterogeneity of the results makes it difficult to draw conclusions. The aim of this paper is to review the echocardiographic parameters during anemia and iron deficiency, and their evolution after treatment. Available data suggest that they lead to ventricular and atrial remodeling, a decrease in ventricular contractility, and an alteration of ventricular relaxation, although in heart failure with preserved ejection fraction these changes are not significant. Anemia and iron deficiency also increase systolic pulmonary artery pressure. There is consistent evidence that correction of these comorbidities leads to a reduction in preload and left ventricular cavity dimensions, an improvement in diastolic and load‐independent ventricular systolic function parameters, and a decrease in systolic pulmonary artery pressure. However, the evidence is less consistent about the changes produced in ventricular hypertrophy, load‐dependent systolic function parameters, and E‐wave. Generally, anemia and iron deficiency affect the echocardiographic findings, and correcting these conditions often results in improvement in the affected echocardiographic parameters.

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“…It is intermediate between HFrEF and HFpEF in many respects but distinctly resembles HFrEF in other respects . The dichotomization also disregards the limitations of EF as a classifier, which the authors addressed in part by spline analyses with EF as a continuous variable. Nevertheless, EF is the most commonly used classifier, and the HFrEF, HFmrEF, and HFpEF categories appear to differentiate patient characteristics and response to therapy quite well.…”

Section: Implications For Current Standard Of Care and Future Trialsmentioning

confidence: 99%

Complex relationships between co‐morbidity, outcomes, and treatment effect in heart failure

Lund

2018

European J of Heart Fail

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Left ventricular ejection fraction and heart failure: an indissoluble marriage?

Cited by 58 publications

References 19 publications

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

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

Anemia and iron deficiency in heart failure: a review of echocardiographic features

Complex relationships between co‐morbidity, outcomes, and treatment effect in heart failure

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