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Review
. 2020 Feb;17(1):1-8.
doi: 10.1007/s11897-019-00451-0.

Heart Failure With Mid-range Ejection Fraction

Pratyaksh K Srivastava  1 , Jeffrey J Hsu  1 , Boback Ziaeian  1   2 , Gregg C Fonarow  3   4
Affiliations
Review

Heart Failure With Mid-range Ejection Fraction

Pratyaksh K Srivastava et al. Curr Heart Fail Rep. 2020 Feb.

Abstract

Purpose of review: To describe the epidemiology, pathophysiology, management, and prognosis of patients with heart failure with mid-range ejection fraction (HFmrEF).

Recent findings: In 2013, The American Heart Association (AHA)/American College of Cardiology (ACC) assigned an ejection fraction (EF) range to heart failure with reduced ejection fraction (HFrEF, EF ≤ 40%) and heart failure with preserved ejection fraction (HFpEF, EF ≥50%). This classification created a "gray zone" of patients with EFs between 41% and 49% that ultimately came to be known as heart failure with borderline or mid-range ejection fraction. HFmrEF patients represent a group with heterogeneous clinical characteristics that at times resembles HFrEF, at others HFpEF, and at others still a unique phenotype altogether. No randomized controlled trials exist in those with HFmrEF, though HFrEF and HFpEF studies that include overlap suggest some potential benefit of beta blockers, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors. Mortality rates among the HFmrEF population are significant, and are similar to those in patients with HFrEF and HFpEF. HFmrEF is a complex disorder that remains poorly understood. Future research is needed to better elucidate the pathophysiology, management, and prognosis of this condition.

Keywords: Heart failure; Mid-range ejection fraction.

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Conflict of interest statement

Conflict of Interest PKS and JJH have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Medical therapy in heart failure. Proven cardiovascular benefit (green check). Potential cardiovascular benefit (yellow check). Uncertain cardiovascular benefit (question mark). No cardiovascular benefit (red x). Abbreviations: ACEi, Angiotensin Converting Enzyme Inhibitor; ARB, Angiotensin Receptor Blocker; ARNI, Angiotensin Receptor-Neprilysin Inhibitor; HFmrEF, Heart Failure with Mid-Range Ejection Fraction; HFpEF, Heart Failure with Preserved Ejection Fraction; HFrEF, Heart Failure with Reduced Ejection Fraction; MRA, Mineralocorticoid Receptor Antagonist; SGLT2i, Sodium-Glucose Cotransporter-2 Inhibitors
See this image and copyright information in PMC

References

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    2. This reference first defined heart failure with borderline ejection fraction.

    1. Lam CS, Solomon SD. The middle child in heart failure: heart failure with mid-range ejection fraction (40–50%). Eur J Heart Fail. 2014;16(10):1049–55 - PubMed

    2. This reference first coined the term, “Heart Failure with Mid-Range Ejection Fraction”.

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