Abstract
BackgroundHeart failure (HF) with mid-range ejection fraction (EF) (HFmrEF) has attracted increasing attention in recent years. However, the understanding of HFmrEF remains limited, especially among Asian patients. Therefore, analysis of a Chinese HF registry was undertaken to explore the clinical characteristics and prognosis of HFmrEF.MethodsA total of 755 HF patients from a multi-centre registry were classified into three groups based on EF measured by echocardiogram at recruitment: HF with reduced EF (HFrEF) (n = 211), HFmrEF (n = 201), and HF with preserved EF (HFpEF) (n = 343). Clinical data were carefully collected and analyzed at baseline. The primary endpoint was all-cause mortality and cardiovascular mortality while the secondary endpoints included hospitalization due to HF and major adverse cardiac events (MACE) during 1-year follow-up. Cox regression and Logistic regression were performed to identify the association between the three EF strata and 1-year outcomes.ResultsThe prevalence of HFmrEF was 26.6% in the observed HF patients. Most of the clinical characteristics of HFmrEF were intermediate between HFrEF and HFpEF. But a significantly higher ratio of prior myocardial infarction (p = 0.002), ischemic heart disease etiology (p = 0.004), antiplatelet drug use (p = 0.009), angioplasty or stent implantation (p = 0.003) were observed in patients with HFmrEF patients than those with HFpEF and HFrEF. Multivariate analysis showed that the HFmrEF group presented a better prognosis than HFrEF in all-cause mortality [p = 0.022, HR (95%CI): 0.473(0.215–0.887)], cardiovascular mortality [p = 0.005, HR (95%CI): 0.270(0.108–0.672)] and MACE [p = 0.034, OR (95%CI): 0.450(0.215–0.941)] at 1 year. However, no significant differences in 1-year outcomes were observed between HFmrEF and HFpEF.ConclusionHFmrEF is a distinctive subgroup of HF. The strikingly prevalence of ischemic history among patients with HFmrEF might indicate a key to profound understanding of HFmrEF. Patients in HFmrEF group presented better 1-year outcomes than HFrEF group. The long-term prognosis and optimal medications for HFmrEF require further investigations.
Highlights
Heart failure (HF) with mid-range ejection fraction (EF) (HFmrEF) has attracted increasing attention in recent years
After excluding 235 subjects with missing left ventricular ejection fraction (LVEF), 755 HF patients from 24 hospitals were included in the analysis
The final multivariate Cox regression models (Table 4) revealed the same trend after adjusting for common factors related with outcomes: HF with mid-range EF (HFmrEF) had a better prognosis than HF with reduced EF (HFrEF) in all-cause mortality [p = 0.022, hazard ratio (HR) (95%confidence intervals (CI)): 0.473(0.215– 0.887)], cardiovascular mortality [p = 0.005, HR (95%CI): 0.270(0.108–0.672)] and major adverse cardiac events (MACE) [p = 0.034, odds ratio (OR) (95%CI): 0.450(0.215–0.941)], but was comparable with HF with preserved EF (HFpEF). 1year Kaplan-Meier survival curves of the three EF strata present significant differences in all-cause mortality (p = 0.003) and cardiovascular mortality (p < 0.001) (Fig. 4)
Summary
Heart failure (HF) with mid-range ejection fraction (EF) (HFmrEF) has attracted increasing attention in recent years. It has been increasingly recognized that HF patients with an intermediate EF (40 to 49%), which represent approximately 10–20% of all HF cases [1,2,3,4,5,6,7,8,9,10,11,12], may be a clinically distinct group To better serve this patient population, the 2016 European Society of Cardiology (ECS) guidelines listed HF with mid-range EF (HFmrEF; EF 40–49%) as a separate group, parallel to HFrEF and HFpEF, in order to promote research about its underlying characteristics, pathophysiology and treatment [13]. HFmrEF should be considered as a distinct HF subpopulation that requires its own evidencebased therapy
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