Left ventricular ejection fraction as therapeutic target: is it the ideal marker?

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Heart failure (HF) is a growing clinical concern, with current classification based on left ventricular ejection fraction (LVEF).
• Two-dimensional echocardiography, used for LVEF estimation, has limitations, including measurement variability and potential for LVEF recovery post-treatment.
• This variability challenges existing HF categories (HFpEF, HFrEF, HFmrEF) and patient stratification.

Purpose of the Study:

• To review and summarize interventions aimed at improving systolic function in patients with reduced LVEF (HFrEF).
• To explore both established and novel pharmacologic, non-pharmacologic, and device-based treatment strategies for HF.
• To propose an updated HF classification acknowledging LVEF recovery.

Main Methods:

• Comprehensive literature review of pharmacologic treatments (e.g., beta-blockers, RAAS inhibitors, sacubitril-valsartan, ranolazine, ivabradine).
• Assessment of non-pharmacologic interventions including cardiac resynchronization therapy and exercise training.
• Consideration of innovative therapies such as stem cells, xanthine oxidase inhibitors, antibiotics, and omega-3 fatty acids.

Main Results:

• Established and novel pharmacotherapies demonstrate potential for improving LVEF in HFrEF patients.
• Cardiac resynchronization therapy and exercise programs show efficacy in enhancing systolic function.
• Emerging strategies like stem cells and specific nutraceuticals warrant further investigation for LVEF recovery.

Conclusions:

• Left ventricular ejection fraction (LVEF) is dynamic and can improve with various interventions in heart failure (HF).
• A new category for HF patients with recovered LVEF should be considered alongside existing classifications.
• Advanced imaging and biomarkers are crucial for accurate HF assessment and identifying candidates for LVEF-guided therapy.