These data clearly point to a need for close clinical follow-up in order to determine whether the current HFmrEF phenotype in the patients we are examining represents a stable stage of mild disease or a transitional step towards different LVEF levels.ĭiagnosis of HFmrEF: Role of Multimodality Imaging 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). Transition from HFmrEF towards preserved LVEF has been reported in 25–44% of patients, and towards reduced LVEF in 16–33% of patients. Research has increasingly confirmed that, among all HF phenotypes, EF variations are most common in HFmrEF. HF phenotypes do not unusually represent transitory stages due to fluctuations in LV volumes and systolic function. Finally, the Chinese HF registry reported a prevalence of HFmrEF of 26.6% within the HF population, with no differences in trends between urban and rural areas. In the US, HFmrEF has been reported to account for 13–24% of patients with HF. In the Swedish HF registry, 21% of all hospitalised HF patients had HFmrEF. Therefore, to obtain putative epidemiological information, we rely on subanalyses of clinical registries and on investigations that report the prevalence of different EF values within the populations under investigation.Ī recent analysis of the Get With The Guidelines-HF (GWTG-HF) registry, which provides data on almost 100,000 patients hospitalised acute HF from 2005 to 2013, found that HFmrEF accounted for 13% of cases. This article focuses on the epidemiology, clinical characteristics and therapeutic approaches to HFmrEF with the aim of discussing the major determinants of transition to preserved or reduced EF.Įxtensive data are lacking about the prevalence of HFmrEF because there have been no population-based clinical studies and most epidemiological studies have divided HF patients into two groups using an EF cut-off value of 50%. Therefore, whether this is a unique subtype of HF patients or whether it represents a ‘transition phase’ from HFrEF to HFpEF or vice versa is still a matter of debate. However, a considerable number of HFmrEF patients experience improvement in LVEF, even to normal values. In recent years, increasing evidence has emerged that HFmrEF may represent a subgroup of HF patients with a peculiar clinical, biomarker and diagnostic profile. The 2016 European Society of Cardiology (ESC) guidelines on acute and chronic HF established an HF category of ‘HF with mid-range ejection fraction’ (HFmrEF), defined as EF between 40% and 49% in patients with HF, to promote research into the main characteristics of this separate group of patients. Historically, HF has been classified according to LV ejection fraction (EF) as either HF with reduced EF (HFrEF LVEF 50%). Heart failure (HF) is a complex syndrome caused by functional and structural abnormalities of the left ventricle (LV) resulting in a combination of typical signs and symptoms.
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