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Heart failure with mid-range ejection fraction: Current evidence and uncertainties.

Raffaele Martone1, Niccolò Marchionni, Francesco Cappelli

  • 1Careggi University Hospital, Cardiovascular and Thoracic Department. cappellifrancesco@inwind.it.

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Heart failure with mid-range ejection fraction (HFmrEF) may be a distinct condition, presenting an intermediate phenotype. Further research is needed to clarify its unique pathophysiology and optimal treatments.

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Area of Science:

  • Cardiology
  • Heart Failure Research

Background:

  • Heart failure with mid-range ejection fraction (HFmrEF) is a recently defined category, representing up to 20% of heart failure patients.
  • Its distinct pathophysiological and clinical entity remains debated, potentially bridging reduced and preserved ejection fraction phenotypes.

Purpose of the Study:

  • To explore the concept of HFmrEF as a distinct clinical entity.
  • To investigate the pathophysiology, clinical characteristics, and potential therapeutic responses in HFmrEF patients.

Main Methods:

  • Review of current evidence and European Society of Cardiology guidelines.
  • Analysis of patient phenotypes, comorbidities, and etiological factors.

Main Results:

  • HFmrEF patients exhibit an intermediate phenotype regarding age, gender, and comorbidities.
  • A significant overlap exists with heart failure with reduced ejection fraction (HFrEF), particularly in ischemic etiology.
  • Etiology, rather than ejection fraction alone, may be key to understanding HFmrEF.

Conclusions:

  • HFmrEF may represent a unique clinical entity, but its pathophysiology requires further elucidation.
  • Understanding the underlying etiology is crucial for managing HFmrEF.
  • Evidence for common heart failure therapies in HFmrEF is sparse, necessitating further clinical trials.