The prognosis of mid‐range ejection fraction heart failure: a systematic review and meta‐analysis

Altaie, Saif; Khalife, Wissam

doi:10.1002/ehf2.12353

Cited by 41 publications

(53 citation statements)

References 36 publications

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“…These findings are in concordance with recently published large scale meta-analysis, highlighting the distinct prognostic role of mid-range LVEF group. 20,21 We were able to demonstrate that patients with impaired LVEF at baseline irrespective of initial clinical presentation (stable CAD or ACS) remain at increased risk of death compared to patients with either preserved or mid-range impaired LV function throughout 5 years. Most studies, of heart failure with depressed systolic function, report only a single LVEF measurement, generally obtained at baseline.…”

Section: Discussionmentioning

confidence: 82%

Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

Siontis

Branca

Serruys

et al. 2019

Eur J Prev Cardiolog

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Aims To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention. Methods and results Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40–49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75–3.28, p < 0.001) and 1.68 (95% confidence interval 1.34–2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons). Conclusion Patients with reduced LVEF <40% or mid-range LVEF 40–49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.

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Section: Discussionmentioning

confidence: 82%

Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

Siontis

Branca

Serruys

et al. 2019

Eur J Prev Cardiolog

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“…The composite outcome of all-cause death or HF rehospitalization was not different among these distinct groups. 17,19 On the other hand, a meta-analysis demonstrated that HFmrEF had a lower rate of cardiac mortality than HFrEF. 20 This discrepancy might be due to the difference in patient characteristics and treatment in each cohort.…”

Section: Discussionmentioning

confidence: 99%

Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction

et al. 2020

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Aims Spironolactone has been shown to improve outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). We investigated whether the discharge use of spironolactone could be associated with better long‐term outcomes among patients with HF with mid‐range EF (HFmrEF). Methods and results We analysed HFmrEF (left ventricular EF 40–49%) patients enrolled in the Japanese Cardiac Registry of Heart Failure in Cardiology, which prospectively studied the clinical characteristics, treatments, and long‐term outcomes of patients hospitalized due to HF. Patients were divided into two groups according to the use of spironolactone at discharge. The primary outcome was a composite of all‐cause death or HF rehospitalization. A total of 457 patients had HFmrEF. The mean age was 69.3 years and 286 (62.6%) were male. Among them, spironolactone was prescribed at discharge in 158 patients (34.6%). Chronic kidney disease (7.6% vs. 16.8%, P = 0.007) was less prevalent and loop diuretics (89.2% vs. 70.2%, P < 0.001) were more often prescribed in patients with spironolactone. During a mean follow‐up of 2.2 years, patients with spironolactone had a lower incidence rate of the primary outcome than those without it (171.5 vs. 278.8 primary outcome per 1000 patient‐years, incidence rate ratio 0.61, 95% confidence interval 0.44–0.86; P = 0.004). After multivariable adjustment, spironolactone use at discharge was associated with a significant reduction in the composite of all‐cause death or HF rehospitalization (adjusted hazard ratio 0.63, 95% confidence interval 0.44–0.90, P = 0.010). Conclusions Among patients with HF hospitalized for HFmrEF, spironolactone use at discharge was associated with better long‐term outcomes.

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“…[ 28 ] In the meta-analysis of Altaie et al, only a few outcomes differed between HF phenotypes: patients with HFmrEF had a lower rate of all-cause death than those with HFrEF, whereas patients in the HFpEF group had a higher rate of cardiac mortality than those in the HFmrEF group. [ 69 ] With regard to sudden cardiac death, Pascual-Figaz et al revealed a higher risk for HFmrEF than HFpEF patients (HR 2.73; 95% CI [1.07–6.98]; p=0.036). [ 70 ] Conversely, non-cardiac mortality was higher among patients with HFrEF than HFmrEF.…”

Section: Prognosismentioning

confidence: 99%

Heart Failure With Mid-range or Recovered Ejection Fraction: Differential Determinants of Transition

et al. 2020

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The recent definition of an intermediate clinical phenotype of heart failure (HF) based on an ejection fraction (EF) of between 40% and 49%, namely HF with mid-range EF (HFmrEF), has fuelled investigations into the clinical profile and prognosis of this patient group. HFmrEF shares common clinical features with other HF phenotypes, such as a high prevalence of ischaemic aetiology, as in HF with reduced EF (HFrEF), or hypertension and diabetes, as in HF with preserved EF (HFpEF), and benefits from the cornerstone drugs indicated for HFrEF. Among the HF phenotypes, HFmrEF is characterised by the highest rate of transition to either recovery or worsening of the severe systolic dysfunction profile that is the target of disease-modifying therapies, with opposite prognostic implications. This article focuses on the epidemiology, clinical characteristics and therapeutic approaches for HFmrEF, and discusses the major determinants of transition to HFpEF or HFrEF.

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The prognosis of mid‐range ejection fraction heart failure: a systematic review and meta‐analysis

Abstract: We detected a significant difference between HFrEF and HFmrEF regarding all-cause death, and non-cardiac death, while HFpEF differed significantly from HFmrEF regarding cardiac death.

Cited by 41 publications

References 36 publications

Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

Spironolactone use is associated with improved outcomes in heart failure with mid‐range ejection fraction

Heart Failure With Mid-range or Recovered Ejection Fraction: Differential Determinants of Transition

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