Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence
1
Division of Cardiology, University of Patras, 26504 Rio, Greece
2
Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
3
Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA
4
Division of Cardiology, Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(2), 203; https://doi.org/10.3390/jcm10020203
Received: 11 December 2020
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Revised: 1 January 2021
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Accepted: 4 January 2021
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Published: 8 January 2021
(This article belongs to the Special Issue Epidemiology, Diagnosis, Pathophysiology, Risk Stratification, and Therapy of Heart Failure with Preserved Ejection Fraction)
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 β-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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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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MDPI and ACS Style
Koufou, E.-E.; Arfaras-Melainis, A.; Rawal, S.; Kalogeropoulos, A.P. Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence. J. Clin. Med. 2021, 10, 203. https://doi.org/10.3390/jcm10020203
AMA Style
Koufou E-E, Arfaras-Melainis A, Rawal S, Kalogeropoulos AP. Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence. Journal of Clinical Medicine. 2021; 10(2):203. https://doi.org/10.3390/jcm10020203
Chicago/Turabian StyleKoufou, Eleni-Evangelia, Angelos Arfaras-Melainis, Sahil Rawal, and Andreas P. Kalogeropoulos. 2021. "Treatment of Heart Failure with Mid-Range Ejection Fraction: What Is the Evidence" Journal of Clinical Medicine 10, no. 2: 203. https://doi.org/10.3390/jcm10020203
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