Heart failure (HF) affects over 6 million adults in the United States. Although not
without its criticism, HF has been classified based on left ventricular ejection fraction
(LVEF) into 2 major phenotypes: HF with reduced ejection fraction (HFrEF) with EF
<40% and HF with preserved ejection fraction (HFpEF) with EF >50%. This classification
leaves a grey zone of 40%-49%. Results from the Acute Decompensated HF Registry (ADHERE)
and Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with
HF (OPTIMIZE-HF) studies suggest that individuals with mildly reduced EF demonstrate
distinct baseline characteristics and outcomes different from HFrEF and HFpEF patients.
1
,- Sweitzer NK
- Lopatin M
- Yancy CW
- et al.
Comparison of clinical features and outcomes of patients hospitalized with heart failure
and normal ejection fraction (>or =55%) versus those with mildly reduced (40% to 55%)
and moderately to severely reduced (<40%) fractions.
Am J Cardiol. 2008; 101: 1151-1156
2
This grey zone was first officially described in American College of Cardiology/American
Heart Association 2013 guidelines as HF with borderline EF
3
and later christened HF with mid-range EF (HFmrEF) in the European Society of Cardiology
2016 guideline.
4
- Ponikowski P
- Voors AA
- Anker SD
- et al.
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:
The Task Force for the diagnosis and treatment of acute and chronic heart failure
of the European Society of Cardiology (ESC) Developed with the special contribution
of the Heart Failure Association (HFA) of the ESC.
Eur Heart J. 2016; 37: 2129-2200
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References
- Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (>or =55%) versus those with mildly reduced (40% to 55%) and moderately to severely reduced (<40%) fractions.Am J Cardiol. 2008; 101: 1151-1156
- OPTIMIZE-HF Investigators and Coordinators. Prospective evaluation of beta-blocker use at the time of hospital discharge as a heart failure performance measure: results from OPTIMIZE-HF.J Card Fail. 2007; 13: 722-731
- 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 62: e147-e239
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016; 37: 2129-2200
- Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction.JACC Heart Fail. 2016; 4: 464-472
- Epidemiology and one‐year outcomes in patients with chronic heart failure and preserved, mid‐range and reduced ejection fraction: an analysis of the ESC Heart Failure Long‐Term Registry.Eur J Heart Fail. 2017; 19: 1574-1585
- Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain).BMJ. 2017; 7e018719
- Heart failure with mid-range (Borderline) ejection fraction: clinical implications and future directions.JACC Heart Fail. 2017; 5: 763-771
- Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction.Eur J Heart Fail. 2017; 19: 1606-1614
- Clinical characteristics, comorbidities and prognosis in patients with heart failure with mid-range ejection fraction.Am J Med Sci. 2020; 359: 325-333
Article info
Publication history
Published online: April 30, 2020
Accepted:
April 24,
2020
Received:
April 7,
2020
Identification
Copyright
© 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
