What have we learned about heart failure with mid‐range ejection fraction one year after its introduction?

Abstract

The 2016 European Society of Cardiology heart failure guidelines introduced the term 'heart failure with mid-range ejection fraction' (HFmrEF) to refer to patients with heart failure and a mildly reduced ejection fraction of 40-49%. About 20% of heart failure patients fall in this category. One of the main reasons for the introduction of this category was to stimulate research into this grey area. This review aims to highlight the key findings that have been published so far. Firstly, HFmrEF more closely resembles heart failure with reduced (HFrEF) than preserved ejection fraction (HFpEF) with regard to ischaemic aetiology, which is more frequent in both HFmrEF and HFrEF compared to HFpEF. Secondly, changes in ejection fraction over time are common, and seem to be more important than baseline ejection fraction alone. Patients who progress from HFmrEF to HFrEF have a worse prognosis than those who remain stable or transition to HFpEF. Lastly, and perhaps most importantly, retrospective analyses from a randomized trial suggest that patients with HFmrEF seem to benefit from therapies that have shown to improve outcome in HFrEF, whereas no such benefit was seen in patients with HFpEF.

Highlights in heart failure

“…[170][171][172][173][174][175][176] With Highlights in heart failure respect of outcomes, prognosis of the patients with HFmrEF is slightly better than that of the patients with HFrEF in most, but not all, 177 of the studies. a LVEF between 40% and 49% (HFmrEF).…”

July 2018 at a glance: practical guidance in acute heart failure, pathophysiology and clinical trials of medical therapy

“…The clinical significance of HF with mid‐range ejection fraction (HFmrEF), first introduced in the 2016 ESC HF guidelines, has become clearer in the last year . Abdul‐Rahim et al .…”

December 2017 at a glance: left ventricular ejection fraction, exercise capacity, peripartum cardiomyopathy

“…The 2016 European Society of Cardiology (ESC) guidelines on heart failure (HF) introduced the term of HF with mid‐range ejection fraction (HFmrEF) for those patients with a left ventricular ejection fraction (LVEF) of 40–49% . This new classification has fostered studies describing these patients' characteristics …”