Heart Failure with Mid-Range Ejection Fraction - State of the Art

Mesquita, Evandro Tinoco; Barbetta, Letícia Mara dos Santos; Correia, Eduardo Thadeu de Oliveira

doi:10.5935/abc.20190079

Cited by 17 publications

(27 citation statements)

References 41 publications

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“…Patients with HF are categorized according to their ejection fraction into patients with HF with reduced EF (HFrEF), ie, EF≤40%, patients with HF and mid-range EF (HFmrEF), ie, EF between 41% and 49% and patients with HF and preserved EF, ie, EF≥50% (HFpEF). 27,28 This classification was proposed by the European society of cardiology (ESC) for the determination of the etiology of HF and for deciding the best treatment modality for different patients. 11,28 In this study, echocardiographic findings were studied in 2000 patients with HF in Saudi Arabia.…”

Section: Discussionmentioning

confidence: 99%

<p>Echocardiographic and Clinical Correlates of Ejection Fraction Among 2000 Patients with Heart Failure in Western Saudi Arabia</p>

Subki¹,

Almalki²,

Butt³

et al. 2020

IJGM

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Introduction: Heart failure (HF) affects about 320,000 Saudi individuals and is associated with a considerable negative impact on the patients' quality of life. In literature, there is a lack of data about the echocardiographic abnormalities of HF patients in Saudi Arabia. Aim of Work: To describe the echocardiographic findings of HF patients in Western Saudi Arabia. Methodology: This was a retrospective record review study conducted on 2000 patients with chronic HF in Saudi Arabia. Demographic, clinical and echocardiographic data were collected and compared among patients with HF with reduced ejection fraction (HFrEF), ie, EF≤40%; HF with mid-range EF (HFmrEF), ie, EF=41-49%; and HF with preserved EF (HFpEF), ie, EF≥50%. Results: Among the 2000 patients studied, females constituted 46.3% of the sample. About 52% of females had HFpEF, whilst 70% of males had HFrEF (p<0.0001). Diastolic dysfunction occurred in 98% of HFpEF versus 78% of HFrEF (p<0.0001). Patients with HFrEF had higher left-ventricular diastolic (LVd) volume (1536 versus 826), higher left-ventricular systolic (LVs) volume (1660 vs 772), higher left atrial volume (1344 vs 875), higher aortic root dimension (1144 vs 929) and lower fractional shortening (FS) (267 vs 1213) than patients with HFpEF (p<0.0001). Conclusion:HFpEF was more common among females and was associated with higher rates of diastolic dysfunction and higher FS. HFrEF was prevalent among males and associated with higher LVd, LVs, left atrium volume and aortic root dimensions.

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Section: Discussionmentioning

confidence: 99%

<p>Echocardiographic and Clinical Correlates of Ejection Fraction Among 2000 Patients with Heart Failure in Western Saudi Arabia</p>

Subki¹,

Almalki²,

Butt³

et al. 2020

IJGM

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“…In the group of patients with HFmrEF, people with T2DM were older than patients without T2DM, no gender difference was registered, and the most common comorbidity was CKD, whose incidence was higher than in patients without T2DM. The literature has described that patients with HFmrEF and T2DM have higher NYHA class and more comorbidities, including ischemic heart disease, hypertension, and COPD (17,19).…”

Section: Discussionmentioning

confidence: 99%

Patients characteristics and prognostic implications of type 2 diabetes mellitus in heart failure with preserved, mid-rang reduced and reduced ejection fraction

Mrvošević¹,

Polovina²

2021

Medicinski podmladak

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Introduction: Type 2 diabetes mellitus (T2DM) is frequent in patients with heart failure (HF) and correlated with an increased morbidity and mortality. The features and outcomes of patients with and without T2DM, depending on the HF type (HF with preserved: HFpEF, mid-range: HFmrEF; and reduced ejection fraction: HFrEF), are inefficiently explored. Aim: To explore the impact of T2DM on clinical features and one-year overall mortality in patients with HFrEF, HFmrEF and HFpEF. Material and methods: A prospective, observational study was conducted, including patients with HF at the Department of Cardiology, Clinical Center of Serbia, Belgrade. The enrolment occurred between November 2018 and January 2019. The study outcome was one-year all-cause mortality. Results: Study included 242 patients (mean-age, 71 ± 13 years, men 57%). T2DM was present in 31% of patients. The proportion of T2DM was similar amid patients with HFrEF, HFmrEF, and HFpEF. Regardless of the HF type, patients with T2DM were probably older and had a higher prevalence of myocardial infarction, other types of coronary disorder or peripheral arterial disorder (all p < 0.001). Also, chronic kidney disease was more prevalent in T2DM (p < 0.001). In HFpEF, T2DM patients were commonly female, and usually had hypertension and atrial fibrillation (all p < 0.001). Estimated one-year total mortality rates were significantly higher in T2DM patients. It also emerged as a unique predictor of higher mortality in HFrEF (HR; 1.33; 95% CI; 1.34 - 2.00), HFmrEF (HR; 1.13; 95% CI; 1.0 - 1.24) and HFpEF (HR; 1.21; 95% CI; 1.09 - 1.56), all p < 0.05. Conclusion: Compared with non-diabetics, patients with HF and T2DM are older, with higher prevalence of comorbidities and greater one-year mortality, regardless of HF type. Heart failure is a unique predictor of mortality in all HF types in multivariate analysis. Considering the increased risk, T2DM requires meticulous screening/diagnosis and contemporary treatment to improve outcomes.

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“…Mesquita et al subdivided the HFmrEF population into three different categories according to LVEF transition, namely recovered HF (73%; from HFrEF to HFmrEF), impaired HF (17%; from HFpEF to HFmrEF) and unchanged (10%; showing no changes in EF during follow-up). [ 10 ]…”

Section: Epidemiologymentioning

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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Heart Failure with Mid-Range Ejection Fraction - State of the Art

Cited by 17 publications

References 41 publications

<p>Echocardiographic and Clinical Correlates of Ejection Fraction Among 2000 Patients with Heart Failure in Western Saudi Arabia</p>

<p>Echocardiographic and Clinical Correlates of Ejection Fraction Among 2000 Patients with Heart Failure in Western Saudi Arabia</p>

Patients characteristics and prognostic implications of type 2 diabetes mellitus in heart failure with preserved, mid-rang reduced and reduced ejection fraction

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

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