Journal
JOURNAL OF CLINICAL MEDICINE
Volume 10, Issue 2, Pages -Publisher
MDPI
DOI: 10.3390/jcm10020203
Keywords
heart failure; heart failure with mid-range ejection fraction; therapy; left ventricular systolic function; beta blockers; angiotensin-converting enzyme inhibitors; angiotensin receptor blockers; mineralocorticoid receptor antagonists; survival; outcomes
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Most studies suggest that patients with HFmrEF have an intermediate clinical background compared to those with HFrEF and HFpEF. Current evidence shows that HFmrEF patients benefit from medications targeting the neurohormonal axes, similar to HFrEF.
In this review, we briefly outline our current knowledge on the epidemiology, outcomes, and pathophysiology of heart failure (HF) with mid-range ejection fraction (HFmrEF), and discuss in more depth the evidence on current treatment options for this group of patients. In most studies, the clinical background of patients with HFmrEF is intermediate between that of patients with HF and reduced ejection fraction (HFrEF) and patients with HF and preserved ejection fraction (HFpEF) in terms of demographics and comorbid conditions. However, the current evidence, stemming from observational studies and post hoc analyses of randomized controlled trials, suggests that patients with HFmrEF benefit from medications that target the neurohormonal axes, a pathophysiological behavior that resembles that of HFrEF. Use of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sacubitril/valsartan is reasonable in patients with HFmrEF, whereas evidence is currently scarce for other therapies. In clinical practice, patients with HFmrEF are treated more like HFrEF patients, potentially because of history of systolic dysfunction that has partially recovered. Assessment of left ventricular systolic function with contemporary noninvasive modalities, e.g., echocardiographic strain imaging, is promising for the selection of patients with HFmrEF who will benefit from neurohormonal antagonists and other HFrEF-targeted therapies.
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