Treatment of Heart Failure With Mid-Range Ejection Fraction: A Summary of Current Evidence.

Teng Ma,Dachun Xu,Yang Su,Jing Song

doi:10.3389/fcvm.2021.653336

Abstract

Heart failure (HF) is a complex syndrome causing heavy burden in public health, and the modern objective assessment of it is based on the left ventricular ejection fraction (LVEF). In 2016, the European Society of Cardiology classified the “gray area” in HF with LVEF of 40–49% as a new HF phenotype (HFmrEF) in an attempt to uncover the specific characteristics and treatment of these patients, which might recover or worsen to HFpEF or HFrEF, respectively, or conversely from these two subtypes. Up to now, many studies have demonstrated that patients with HFmrEF would possibly gain more benefits from some targeted therapies with HFrEF than those with HFpEF. This review summarizes what is known about the findings in the treatment of HFmrEF and discusses what should be done to better define the peculiar HF phenotype in the future.

Highlights

Heart failure (HF) is a complex clinical syndrome characterized by reduced cardiac output and/or elevated filling pressures at rest or with exertion
Cleland et al [12] used a meta-analysis of randomized controlled trials to demonstrate that beta-blockers may reduce CV death in HF with mid-range ejection fraction (HFmrEF) patients in sinus rhythm compared with placebo [HR 0.48; 95% CI (0.24–0.97); p = 0.04] and improve left ventricular systolic function with a higher left ventricular ejection fraction (LVEF) using data from double-blind, randomized, placebo-controlled trials
The pooled analysis containing a total cohort of 13,195 patients suggested that patients with LVEF lower than normal, including HFmrEF or borderline ejection fraction, would possibly benefit, in the combined end-point of cardiovascular mortality and first hospitalization for heart failure (HF), from sacubitril/valsartan compared with RAS inhibition

Summary

INTRODUCTION

Heart failure (HF) is a complex clinical syndrome characterized by reduced cardiac output and/or elevated filling pressures at rest or with exertion. The pooled analysis containing a total cohort of 13,195 patients suggested that patients with LVEF lower than normal, including HFmrEF or borderline ejection fraction, would possibly benefit, in the combined end-point of cardiovascular mortality and first hospitalization for HF, from sacubitril/valsartan compared with RAS inhibition. These therapeutic benefits appeared to extend to a higher LVEF range in women compared with men. A study suggested that combination use of sacubitril/valsartan rather than valsartan

Randomized controlled trial

Full spectrum

OTHER THERAPEUTICS

Findings

CONCLUSION