Pratyaksh K Srivastava1, Jeffrey J Hsu1, Boback Ziaeian1,2, Gregg C Fonarow3,4. 1. Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 2. Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 3. Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. gfonarow@mednet.ucla.edu. 4. Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, CA, 90095-1679, USA. gfonarow@mednet.ucla.edu.
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.
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.
Authors: Sameer Ather; Wenyaw Chan; Biykem Bozkurt; David Aguilar; Kumudha Ramasubbu; Amit A Zachariah; Xander H T Wehrens; Anita Deswal Journal: J Am Coll Cardiol Date: 2012-03-13 Impact factor: 24.094
Authors: Faiez Zannad; John J V McMurray; Henry Krum; Dirk J van Veldhuisen; Karl Swedberg; Harry Shi; John Vincent; Stuart J Pocock; Bertram Pitt Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: Shannon M Dunlay; Véronique L Roger; Susan A Weston; Ruoxiang Jiang; Margaret M Redfield Journal: Circ Heart Fail Date: 2012-08-30 Impact factor: 8.790
Authors: Bertram Pitt; Marc A Pfeffer; Susan F Assmann; Robin Boineau; Inder S Anand; Brian Claggett; Nadine Clausell; Akshay S Desai; Rafael Diaz; Jerome L Fleg; Ivan Gordeev; Brian Harty; John F Heitner; Christopher T Kenwood; Eldrin F Lewis; Eileen O'Meara; Jeffrey L Probstfield; Tamaz Shaburishvili; Sanjiv J Shah; Scott D Solomon; Nancy K Sweitzer; Song Yang; Sonja M McKinlay Journal: N Engl J Med Date: 2014-04-10 Impact factor: 91.245
Authors: Philip A Poole-Wilson; Karl Swedberg; John G F Cleland; Andrea Di Lenarda; Peter Hanrath; Michel Komajda; Jacobus Lubsen; Beatrix Lutiger; Marco Metra; Willem J Remme; Christian Torp-Pedersen; Armin Scherhag; Allan Skene Journal: Lancet Date: 2003-07-05 Impact factor: 79.321
Authors: Gregg C Fonarow; Wendy Gattis Stough; William T Abraham; Nancy M Albert; Mihai Gheorghiade; Barry H Greenberg; Christopher M O'Connor; Jie Lena Sun; Clyde W Yancy; James B Young Journal: J Am Coll Cardiol Date: 2007-08-06 Impact factor: 24.094
Authors: John R Kapoor; Roger Kapoor; Christine Ju; Paul A Heidenreich; Zubin J Eapen; Adrian F Hernandez; Javed Butler; Clyde W Yancy; Gregg C Fonarow Journal: JACC Heart Fail Date: 2016-06 Impact factor: 12.035
Authors: Kanan Patel; Gregg C Fonarow; O James Ekundayo; Inmaculada B Aban; Meredith L Kilgore; Thomas E Love; Dalane W Kitzman; Mihai Gheorghiade; Richard M Allman; Ali Ahmed Journal: Int J Cardiol Date: 2014-03-11 Impact factor: 4.164