Abstract
Background
The intermediate group of patients with heart failure (HF) and mid-range left ventricular
ejection fraction (HFmrEF) may constitute a specific phenotype, but a direct evidence
is lacking. This study aimed to know whether this HF category is accompanied by a
particular clinical phenotype and prognosis.
Methods and results
This study includes 3446 ambulatory patients with chronic HF from two national registries.
According to EF at enrollment, patients were classified as reduced (HFrEF, <40%), mid-range (HFmrEF, 40–49%) or preserved (HFpEF, ≥50%). Patients were followed-up for a median of 41 months and the specific cause of death was prospectively registered. Patients with
HFmrEF represented 13% of population and they exhibited a phenotype closer to HFrEF,
except for a higher rate of coronary revascularization and diabetes, and a less advanced
HF syndrome. The observed all-cause mortality was higher among HFrEF (33.0%), and
similar between HFmrEF (27.8%) and HFpEF (28.0%) (p = 0.012); however, the contribution of each cause of death differed significantly between
categories (p < 0.001). After propensity score matching, the risk of cardiovascular death, HF death
or sudden cardiac death did not differ between HFmrEF and HFrEF in paired samples;
however, patients with HFmrEF were at higher risk of cardiovascular death (sHR 1.71,
95% CI 1.13–2.57, p = 0.011) and sudden cardiac death (sHR 2.73, 95% CI 1.07–6.98, p = 0.036) than patients with HFpEF.
Conclusions
Patients in the intermediate category of HFmrEF conform a phenotype closer to the
clinical profile of HFrEF, and associated to higher risk of sudden cardiac death and
cardiovascular death than patients with HFpEF.
Keywords
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Article info
Publication history
Published online: March 09, 2017
Accepted:
March 7,
2017
Received in revised form:
March 1,
2017
Received:
January 27,
2017
Footnotes
☆Each author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
