Related Experiment Video
Updated: Nov 27, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Heart Failure With Midrange Ejection Fraction-What Is It, If Anything?
Jacinthe Boulet1, Emmanuelle Massie1, Jean-Lucien Rouleau1
1Division of Cardiology, Department of Medicine, Montréal Heart Institute, Montréal, Québec, Canada.
Insights
Heart failure with midrange ejection fraction (HFmrEF) patients are a diverse group. Left ventricular ejection fraction (LVEF) is a continuum, not a definitive classification for heart failure.
Area of Science:
- Cardiology
- Clinical Medicine
- Heart Failure Research
Background:
- Heart failure with midrange ejection fraction (HFmrEF), defined by left ventricular ejection fractions (LVEFs) of 41%-49%, constitutes a significant patient subset.
- Despite established guidelines, the clinical significance of HFmrEF remains debated due to patient heterogeneity.
- HFmrEF patients share characteristics with both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).
Purpose of the Study:
- To review the pathophysiologic mechanisms contributing to HFmrEF.
- To delineate the clinical and imaging differences and similarities between HFpEF, HFrEF, and HFmrEF.
- To emphasize the continuum of heart failure and the limitations of LVEF-based classification.
Main Methods:
- Clinical review of existing literature.
- Analysis of pathophysiologic mechanisms, biomarker profiles, comorbidities, and clinical characteristics.
- Comparison of clinical and imaging features across HF phenotypes.
Main Results:
- HFmrEF patients exhibit heterogeneity, overlapping with HFpEF and HFrEF.
- Left ventricular ejection fraction (LVEF) represents a continuum in heart failure, not discrete categories.
- Pathophysiology, etiology, and comorbidities are crucial for understanding and managing HF.
Conclusions:
- Left ventricular ejection fraction (LVEF) is an important but oversimplified measure in heart failure.
- Heart failure is best understood as a continuum, necessitating a personalized approach.
- Focusing on underlying pathophysiology, etiology, and comorbidities is essential for tailored patient care.
Abstract:
The patient cohort with left ventricular ejection fractions (LVEFs) of 41%-49%, which has been defined as heart failure with midrange ejection fraction (HFmrEF), represent a significant proportion of the heart failure (HF) population. Despite the clear cutoffs established by different society guidelines, confusion remains regarding the exact significance of midrange LVEF within the HF syndrome. Patients with LVEF 41%-49% represent a heterogeneous group of patients sharing pathophysiologic mechanisms, biomarker profiles, comorbidities, and clinical characteristics with patients with preserved and reduced LVEF. In this clinical review, we discuss the underlying pathophysiologic mechanisms that culminate in the clinical syndrome of HF and contribute to the disparities observed between HFpEF, HFrEF, and HFmrEF. We highlight differences and similarities in clinical characteristics and imaging features between HFpEF and HFrEF in an effort to disentangle the heterogeneous group of patients with midrange LVEF, but ultimately we conclude that LVEF should be seen as simply one important element of a continuum throughout the HF syndrome, and that although is useful, it is an oversimplification, because HF syndrome is more of a continuum. The underlying pathophysiology, etiology, and comorbidities of patients presenting with HF is becoming ever more important as the limitations of a classification solely based on LVEF are being better recognised, and as patient-specific personalisation of care is becoming ever more important.
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