Heart Failure With Preserved Ejection Fraction


Heart Failure with Mid-range Ejection Fraction: Lessons from CHARM

The cut-off values for “normal” ejection fraction (EF) are poorly defined. The EchoNoRMAL study suggested a lower boundary of 49–57 %.1 The American Society of Echocardiography and European Association of Cardiovascular Imaging consider a normal EF and normal range (±2 SD) as 62 % (52–72 %) in men and 64 % (54–74 %) in women.2 By these criteria, an EF of 40–49 % would not be considered normal.

Ablation for Atrial Fibrillation in Heart Failure with Reduced Ejection Fraction

As the population ages, the incidence of both AF and heart failure (HF) will continue to increase. By the year 2030, there will be an estimated >12 million patients with AF and >8 million patients with HF.1,2 A significant proportion of patients with HF have reduced (<50 %) left ventricular ejection fraction (heart failure with reduced ejection fraction, HFrEF) and the coexistance of AF in patients with AF and HFrEF has been associated with worse outcomes.

Heart Failure with Mid-Range Ejection Fraction and How to Treat It

In 2016, the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC)1 introduced heart failure (HF) with mid-range ejection fraction (HFmrEF) as a distinct phenotype. This distinction was expected to stimulate research on the underlying characteristics, pathophysiology and treatment of patients with HFmrEF. Indeed, in the following 2 years, the number of studies devoted to HFmrEF grew rapidly.

What is Heart Failure with Mid-range Ejection Fraction? A New Subgroup of Patients with Heart Failure

The latest guidelines on the diagnosis and management of heart failure (HF) published by the European Society of Cardiology (ESC) introduced a new class of HF: HF with mid-range ejection fraction (HFmrEF).1 This was in addition to the previously-defined classes: HF with reduced ejection fraction (HFrEF), in which the left ventricular ejection fraction (LVEF) is below 40 %, and HF with preserved ejection fraction (HFpEF), in which the LVEF exceeds 50 %.