What have we learned about heart failure with mid-range ejection fraction one year after its introduction?

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Updated: Feb 20, 2026

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

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Jan F Nauta1, Yoran M Hummel1, Joost P van Melle1

  • 1Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

European Journal of Heart Failure
|October 26, 2017
PubMed

Insights

Heart failure with mid-range ejection fraction (HFmrEF) shares similarities with reduced ejection fraction (HFrEF) and may benefit from HFrEF therapies. Research is ongoing into this distinct heart failure category.

Area of Science:

  • Cardiology
  • Heart Failure Research

Background:

  • The 2016 ESC guidelines defined heart failure with mid-range ejection fraction (HFmrEF) for ejection fraction (EF) of 40-49%.
  • HFmrEF constitutes approximately 20% of heart failure cases, representing an area needing further investigation.
  • This category was established to encourage dedicated research into this patient group.

Purpose of the Study:

  • To review key research findings concerning HFmrEF.
  • To compare HFmrEF characteristics with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
  • To explore the prognostic implications of EF changes and treatment benefits in HFmrEF.

Main Methods:

  • Review of published literature and retrospective analyses from clinical trials.
  • Comparative analysis of HFmrEF against HFrEF and HFpEF based on aetiology, EF dynamics, and treatment response.
  • Examination of prognostic data related to EF trajectory in HFmrEF patients.

Main Results:

  • HFmrEF shares a higher frequency of ischaemic aetiology with HFrEF compared to HFpEF.
  • Ejection fraction variability over time is significant, with progression to HFrEF associated with a poorer prognosis.
  • Retrospective data suggest HFmrEF patients may benefit from therapies proven effective in HFrEF, unlike HFpEF patients.

Conclusions:

  • HFmrEF represents a distinct clinical entity with characteristics aligning more closely with HFrEF.
  • Prognosis in HFmrEF is influenced by the dynamic changes in ejection fraction over time.
  • Evidence suggests potential therapeutic benefits from HFrEF-specific treatments for HFmrEF patients, warranting further investigation.

Keywords:
Heart failureMid-range ejection fractionReview

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