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Related Concept Videos

Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

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Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
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Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart Failure I: Introduction01:27

Heart Failure I: Introduction

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Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
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Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Related Experiment Video

Updated: Oct 21, 2025

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Heart failure with mid-range or mildly reduced ejection fraction.

Gianluigi Savarese1,2, Davide Stolfo1,3, Gianfranco Sinagra3

  • 1Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

Nature Reviews. Cardiology
|September 7, 2021
PubMed
Summary

Heart failure with mid-range ejection fraction (HFmrEF) is a distinct category, often similar to heart failure with reduced ejection fraction (HFrEF). Research suggests HFmrEF patients may benefit from HFrEF treatments, supporting a name change to "mildly reduced EF".

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Area of Science:

  • Cardiology
  • Heart Failure Research

Background:

  • Left ventricular ejection fraction (EF) is crucial for heart failure (HF) management.
  • The 2016 ESC guidelines introduced HF with mid-range EF (HFmrEF; 40-49%), a category needing further exploration.
  • HFmrEF prevalence is 10-25% among HF patients.

Purpose of the Study:

  • To comprehensively review the characteristics and clinical implications of HFmrEF.
  • To compare HFmrEF with heart failure with reduced EF (HFrEF; <40%) and preserved EF (HFpEF; ≥50%).
  • To evaluate potential treatment strategies for HFmrEF based on existing evidence.

Main Methods:

  • Review of existing literature, including post hoc and subgroup analyses of randomized clinical trials.
  • Analysis of data from trials involving SGLT1-SGLT2 inhibitors.
  • Synthesis of evidence regarding clinical features, prognosis, and treatment response in HFmrEF.

Main Results:

  • HFmrEF shares some features with both HFrEF and HFpEF, but is more similar to HFrEF regarding ischaemic heart disease prevalence.
  • Cardiovascular event risk is lower in HFmrEF than HFrEF, but non-cardiovascular event risk is similar or higher.
  • Evidence suggests HFrEF medications may be effective for HFmrEF.

Conclusions:

  • HFmrEF is a clinically relevant category within the spectrum of heart failure.
  • HFmrEF shares significant clinical characteristics with HFrEF.
  • Renaming HFmrEF to "heart failure with mildly reduced EF" is proposed to better reflect its clinical profile and treatment implications.