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Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome

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Abstract

Background

Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort.

Methods and results

The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia. Baseline characteristics, clinical presentation, in-hospital therapies, and short-term mortality (all-cause in-hospital or 30-day mortality, whichever first) were compared among HFrEF (LVEF <40%), HFmrEF (LVEF 40–49%), and HFpEF (LVEF ≥50%) patients. Among 3257 patients with documented LVEF, 52% had HFrEF, 25% HFmrEF, and 23% HFpEF. Patients with HFmrEF had a distinct demographic and clinical profile with many intermediate features between HFrEF and HFpEF. In addition, they had a higher prevalence of hypertension (p < 0.001), a lower prevalence of chronic renal disease (p = 0.003), more hospitalizations for acute coronary syndrome (p < 0.001), or infection (p = 0.003), and were more frequently treated with intravenous vasodilators compared to HFrEF or HFpEF. Adjusted short-term mortality in HFmrEF was lower than HFrEF [hazard ratio (HR) = 0.635 (0.419, 0.963), p = 0.033] but similar to HFpEF [HR = 1.026 (0.605, 1.741), p = 0.923].

Conclusion

Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF.

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Authors and Affiliations

  1. Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece

    Dimitrios Farmakis, Panagiotis Simitsis, Vasiliki Bistola, Ignatios Ikonomidis, Spyridon Katsanos, George Bakosis, Erifili Hatziagelaki, John Lekakis & John Parissis

  2. Department of Cardiology, Larissa University Hospital, Larissa, Greece

    Filippos Triposkiadis

  3. Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France

    Alexandre Mebazaa

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  1. Dimitrios Farmakis
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Correspondence to John Parissis.

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Conflict of interest

DF reports honoraria from Servier and Novartis and an educational grant from Novartis. FT reports honoraria from Servier, Novartis, and Bayer. AM reports honoraria from Abbott USA and Orion Pharma. JP reports honoraria from Servier, Novartis, and Orion Pharma.

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Farmakis, D., Simitsis, P., Bistola, V. et al. Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome. Clin Res Cardiol 106, 359–368 (2017). https://doi.org/10.1007/s00392-016-1063-0

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