Related Experiment Video

Updated: Oct 17, 2025

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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Similarities and Differences Between HFmrEF and HFpEF

Peixin Li1,2,3, Hengli Zhao1,2,3,4, Jianyu Zhang5

  • 1State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Frontiers in Cardiovascular Medicine
|October 7, 2021
PubMed

Insights

New heart failure (HF) guidelines define HF with mid-range EF (HFmrEF) as distinct. Research suggests HFmrEF patients may benefit from reduced EF (HFrEF) treatments, though HFmrEF and HF with preserved EF (HFpEF) share some characteristics.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Clinical Phenotyping

Background:

  • Current heart failure (HF) classification includes HF with reduced EF (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF).
  • HFmrEF, defined by left ventricular ejection fraction (EF) of 40-49%, is recognized as a unique phenotype, prompting further investigation.
  • HFmrEF patients exhibit characteristics intermediate between HFrEF and HFpEF, with similarities in etiology to HFrEF and prognosis to HFpEF.

Purpose of the Study:

  • To review current understanding of HFmrEF and HFpEF, focusing on their epidemiology, etiology, clinical indicators, and pathophysiology.
  • To explore potential treatment strategies for HFmrEF, particularly the efficacy of HFrEF-focused therapies.
  • To discuss the heterogeneity within HFmrEF and HFpEF and its impact on disease prognosis and management.

Main Methods:

  • Review of current clinical practice data.
  • Analysis of mechanistic studies.
  • Examination of observational studies and post-hoc analyses of randomized controlled trials.

Main Results:

  • HFmrEF patients share etiological factors with HFrEF but have a prognosis and quality of life closer to HFpEF.
  • Growing evidence suggests HFmrEF and HFpEF exhibit significant heterogeneity in presentation and pathophysiology.
  • Preliminary data indicate potential benefits of HFrEF treatment strategies (e.g., beta-blockers, ACE inhibitors, ARBs, MRAs, sacubitril/valsartan) for HFmrEF patients.

Conclusions:

  • HFmrEF represents a distinct clinical entity requiring further research into its specific mechanisms and optimal treatment.
  • Understanding the heterogeneity of HFmrEF and HFpEF is crucial for tailoring effective therapeutic approaches.
  • HFrEF treatment paradigms may offer a beneficial therapeutic avenue for patients with HFmrEF, warranting further investigation.

Keywords:
cardiac abnormalityheart failureheart failure with mid-range ejection fractionheart failure with preserved ejection fractionheterogeneity

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