Abstract
Heart failure (HF) is a complex clinical syndrome resulting from the impairment of ventricular filling or ejection of blood or both, leading to considerable morbidity and mortality. Based on left ventricular ejection fraction (LVEF), the 2016 European Society of Cardiology (ESC) guideline firstly classified patients with LVEF in the range of 40% to 49% into heart failure with mid-range ejection fraction. Since then, more and more clinical studies targeting HF with mid-range ejection fraction emerged, indicating that they may benefit from similar therapies to those with LVEF ≤40%. So the latest ESC guideline of HF changed the term 'heart failure with mid-range ejection fraction' to 'heart failure with mildly reduced ejection fraction' (HFmrEF). Simultaneously, burgeoning evidence indicating the emergence of novel technologies (such as speckle tracking echocardiography, cardiac magnetic resonance quantitative imaging), and new biomarkers were conducive to evaluating HF from different perspectives. In this review, we summarized the research progress of HFmrEF in clinical characteristics, prognosis, and treatment, hoping to help cardiologists better evaluate and treat patients of HFmrEF.
Highlights
Heart failure (HF) is a clinical syndrome resulting from the dysfunction of ventricular systolic and/or diastolic function caused by various reasons, leading to an increasing disease burden worldwide
With regard to long-term prognosis, emerging studies demonstrated that the mortality of heart failure with mildly reduced ejection fraction’ (HFmrEF) was 7–42% with a median follow-up time ranged from 1 year to 3 years, which was similar to HF with preserved ejection fraction (HFpEF) and slightly lower than HF with reduced ejection fraction (HFrEF) [7
Chang et al [26] conducted a retrospective study including 273 HFmrEF patients who were divided into three groups in the follow-up period: HF with worse EF (HFwEF) (LVEF 50%), indicating that baseline global longitudinal strain (GLS) was associated with follow-up left ventricular ejection fraction (LVEF) change (HFwEF vs. HFsEF vs. HFrecEF: –7.8% vs. –10.5% vs. –17.5%, p < 0.05)
Summary
Heart failure (HF) is a clinical syndrome resulting from the dysfunction of ventricular systolic and/or diastolic function caused by various reasons, leading to an increasing disease burden worldwide. Patients with LVEF ≤40% and ≥50% were defined as HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), respectively. There have been more clinical studies targeting HF with mid-range ejection fraction. The latest 2021 ESC guideline [3] demonstrated patients with ejection fractions in the 40–50% range may benefit from similar therapies to those with LVEF ≤40%, leading to the change of the term ‘heart failure with mid-range ejection fraction’ to ‘heart failure with mildly reduced ejection fraction’ (HFmrEF). The phenotype and mechanism of HFmrEF were complex, with many characteristics between HFrEF and HFpEF [4,5]. We summarized the research progress of HFmrEF in clinical characteristics, prognosis, and treatment, hoping to help cardiologists better evaluate and treat patients of HFmrEF
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