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Review
. 2020 Apr;7(2):381-399.
doi: 10.1002/ehf2.12586. Epub 2020 Apr 1.

Heart failure with mid-range ejection fraction: pro and cons of the new classification of Heart Failure by European Society of Cardiology guidelines

Luca Branca  1 , Marco Sbolli  1 , Marco Metra  1 , Marat Fudim  2   3
Affiliations
Review

Heart failure with mid-range ejection fraction: pro and cons of the new classification of Heart Failure by European Society of Cardiology guidelines

Luca Branca et al. ESC Heart Fail. 2020 Apr.

Abstract

Currently, the assessment of left ventricular ejection fraction (LVEF) is the cornerstone of the classification of patients with heart failure (HF). The mid-range LVEF (HFmrEF) category was identified in an attempt to uncover specific characteristics of these patients. So far, the analysis of trials, registries, and observational studies have demonstrated that patients with mid-range LVEF belong to a patient cohort with generally intermediate clinical profile as compared with other groups but with a remarkable variety of intrinsic phenotypes. This is due to the limitations of LVEF as the sole criterion to categorize patients with HF and characterize their prognosis, above all when it is >40%. To better define the HFmrEF phenotype, it is reasonable to consider other parameters, such as LVEF changes over time, HF aetiology, co-morbidities, and other imaging parameters. A multiparametric evaluation may contextualize a patient with HFmrEF in a more defined phenotype with a specific prognosis.

Keywords: Classification; Heart failure with mid-range ejection fraction; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Heart failure phenotypes based on left ventricle ejection fraction. HFmrEF, heart failure with mid‐range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 2
Figure 2
Evaluation of HFmrEF beyond LVEF. HFmrEF, heart failure with mid‐range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricle ejection fraction.
Figure 3
Figure 3
HFmrEF on a continuum of disease. HFmrEF, heart failure with mid‐range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
See this image and copyright information in PMC

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