Heart Failure With Mid-range Ejection Fraction: A Distinctive Subtype or a Transitional Stage?

Abstract

Heart failure with mid-range ejection fraction (HFmrEF) was first proposed by Lam and Solomon in 2014, and was listed as a new subtype of heart failure (HF) in 2016 European Society of Cardiology guidelines. Since then, HFmrEF has attracted an increasing amount of attention, and the number of related studies on this topic has grown rapidly. The diagnostic criteria on the basis of left ventricular ejection fraction (LVEF) are straightforward; however, LVEF is not a static parameter, and it changes dynamically during the course of HF. Thus, HFmrEF may not be an independent disease with a uniform pathophysiological process, but rather a collection of patients with different characteristics. HFmrEF is often associated with various cardiovascular and non-cardiovascular diseases. Thus, the pathophysiological mechanisms of HFmrEF are particularly complex, and its clinical phenotypes are diverse. The complexity and heterogeneity of HFmrEF may be one reason for inconsistent results between clinical studies. In fact, whether HFmrEF is a distinctive subtype or a transitional stage between HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) is controversial. In this review, we discuss the clinical characteristics, treatment and prognosis of patients with HFmrEF, as well as the differences among HFmrEF, HFrEF, and HFpEF.

Deep Learning Predicts Heart Failure With Preserved, Mid-Range, and Reduced Left Ventricular Ejection Fraction From Patient Clinical Profiles

“…Furthermore, HFmEF represents onefifth of the HF population and remains ambiguous, as its pathogenesis was observed to be more similar to that of HFrEF and rather different from HFpEF depending on the guidelines applied. This raises the question of whether it should be considered a transient entity between HFpEF and HFrEF or a distinct entity on its own (14)(15)(16). Therefore, additional research is needed to investigate the effectiveness of LVEF-based categorization of HF patients.…”

“…Therefore, additional research is needed to investigate the effectiveness of LVEF-based categorization of HF patients. According to recently published studies, clinical profiles of patients allow for the discrimination between the three HF categories, especially the presence of comorbidities and quality of life based on the ESC guidelines (16)(17)(18)(19)(20)(21). Based on these clinical results, HFmEF patients were found to fall between HFpEF and HFrEF while more closely resembling HFpEF (22,23).…”

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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.…”

Investigating the role of phosphorylated regulatory light chains during heart failure progression

“…Table 1: Biomarkers to classify heart failure condition Despite the challenge in diagnosing HFpEF, recent studies estimate that more than half of all HF patients have a preserved EF, highlighting its prevalence (19). However, the cardiac phenotype can transit from one category to another depending on the progression (e.g., HFpEF  HFrEF) of or recovery (HFrEF  HFpEF) from the disease (20). HFpEF are commonly a result of hypertensive and/or valvular disease.…”

“…HFpEF are commonly a result of hypertensive and/or valvular disease. On the other hand, the main causes of HFmrEF and HFrEF are ischemic heart disease and idiopathic dilated cardiomyopathy (20). Although HFrEF and HFpEF are dynamic, have contrasting clinical characteristics and varying etiologies, their mortality rates (~14%) and prognosis are similar (19,21).…”