Is heart failure with midrange ejection fraction similar to preserved ejection fraction? In favor

Camafort Babkowski, M.

doi:10.1016/j.rceng.2017.01.003

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In favor" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "296" "paginaFinal" => "298" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Camafort Babkowski" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Camafort Babkowski" "email" => array:1 [ 0 => "camafort@ub.edu" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna General, ICMiD Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La insuficiencia cardiaca con fracción de eyección en rango intermedio ¿es similar a la de fracción de eyección preservada? A favor" ] ] "textoCompleto" => "The differentiation of patients with HF based on LVEF echocardiographic values is important due mainly to the fact that it helps establish 2 subtypes: HF with reduced LVEF (<40%) (HFrEF) and HF with preserved LVEF (≥50%) (HFpEF).<a class="elsevierStyleCrossRef" href="#bib0045">1</a> The 2 conditions are differentiated in terms of demographic characteristics, etiological factors, associated comorbidities and treatment.<a class="elsevierStyleCrossRef" href="#bib0045">1</a> Patients with HFrEF are younger and have fewer comorbidities, and their fundamental etiology is ischemic heart disease. Historically, most studies designed to treat HF have focused on patients with HFrEF, with most clinical trials excluding those patients with HFpEF. Therefore, most of the therapeutic evidence (both pharmaceutical and nonpharmaceutical) has been generated from patients with a LVEF typically <35–40%.<a class="elsevierStyleCrossRefs" href="#bib0050">2,3</a>Recently, the European Society of Cardiology has established a new category in the classification of HF based on LVEF.<a class="elsevierStyleCrossRef" href="#bib0055">3</a> This new category is known as HF with mid-range EF (HFmEF) and encompasses all patients with LVEF between 40% and 49%, which until now constituted an undefined “gray area”.<a class="elsevierStyleCrossRef" href="#bib0060">4</a> As with HFpEF, the evidence on its treatment is highly limited. Although this new category currently represents no more than 10%,<a class="elsevierStyleCrossRef" href="#bib0065">5</a> the improvements in treating ischemic heart disease will increasingly lead to more patients with ischemia presenting less myocardial damage, increasing the percentage of those with HFmEF.<a class="elsevierStyleCrossRef" href="#bib0060">4</a>The patterns of the various types of HF have varying characteristics. Thus, patients with HFrEF have primary and symptomatic heart disease as the leading cause of their HF, while those with HFpEF have multiorgan disease in which various phases occur, symptomatic or not.<a class="elsevierStyleCrossRef" href="#bib0055">3</a> Therefore, when establishing whether there are similarities between HFmEF and HFpEF, we need other data (in addition to LVEF) such as natriuretic peptide levels, renal function and comorbidity data that help us make comparisons.A study performed on 1663 patients with HF (of hypertensive, ischemic or idiopathic origin) assessed the presence of left ventricular dysfunction in each of the 3 HF categories (based on their LVEF).<a class="elsevierStyleCrossRef" href="#bib0070">6</a> Sixty-seven percent of the patients had HFrEF, 23% had HFpEF, and the remaining 10% had HFmEF. In terms of the differential characteristics between the various types of HF, the study observed that the patients with HFmEF had a systolic and diastolic blood pressure and a prevalence of atrial fibrillation similar to those with preserved LVEF. Compared with the HFrEF group, the patients with HFpEF and HFmEF had a lower percentage of cases in functional classes III and IV, lower serum BNP concentrations, lower right ventricular dysfunction (defined as tricuspid annular plane systolic excursion [TAPSE] <14%) and a lower percentage of patients with systolic pulmonary artery pressure >40mmHg.<a class="elsevierStyleCrossRef" href="#bib0070">6</a> Unlike the HFpEF group, the patients with HFmEF had more ischemic heart disease; were more frequently treated with angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, beta-blockers and spironolactone and had a greater rate of device implantation.<a class="elsevierStyleCrossRef" href="#bib0070">6</a>In another recent study, Kapoor et al. analyzed a total of 99,825 patients with HF who were hospitalized in 305 centers in the United States from 2005 to 2013.<a class="elsevierStyleCrossRef" href="#bib0075">7</a> Forty-nine percent of the patients were classified as HFrEF, 13% as HFmEF and 38% as HFpEF. The patients with HFmEF had a similar age, sex and comorbidities to those of patients with HFpEF (older, percentage of women and number of comorbidities). However, the HFmEF group had ischemic heart disease as the fundamental cause, similar to the HFrEF group.Another aspect to consider is that patients with HFmEF do not constitute a homogeneous group because, depending on the pathophysiological mechanism, the LVEF can be the result of the recovery of previously reduced systolic function or the result of a systolic function impairment that achieves mid-range LVEF readings.<a class="elsevierStyleCrossRef" href="#bib0080">8</a> A recent study observed that patients with recovered HFmEF had fewer cardiovascular events, as did those who had HFpEF. Nevertheless, this patient group with recovered HFmEF showed biological, epidemiological and echocardiographic characteristics different from those of the other HFpEF and HFrEF groups and could therefore constitute a type with its own identity.<a class="elsevierStyleCrossRef" href="#bib0080">8</a> Nevertheless, one of the main criticisms of this article would be that the authors define HFpEF starting from an LVEF ≥55%. This aspect impedes the differentiation between HFmEF and HFpEF, because a consensus has still not been reached on what constitutes the normal value for LVEF.<a class="elsevierStyleCrossRef" href="#bib0055">3</a>In summary, given that normal LVEF values have not been defined and considering the pathophysiological mechanisms and clinical progression, we can conclude that HFmEF is probably similar to HFpEF. Nevertheless, the evidence is still limited for reaching a definitive conclusion on this fascinating dilemma.Conflicts of interestThe authors declare that they have no conflicts of interest." 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A new category has recently been defined: HF with midrange LVEF (40–49%). When current information is taken into account, this new category is more similar to HF with preserved LVEF than reduced LVEF." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La clasificación de la insuficiencia cardiaca (IC) basada en los valores ecocardiográficos de la fracción de eyección del ventrículo izquierdo (FEVI) ha sido útil para definir 2 subtipos de IC: con FEVI reducida y con FEVI preservada. Recientemente se ha definido una nueva categoría, denominada IC con FEVI en rango medio (40-49%), que teniendo en cuenta la información disponible hasta el momento, posee más similitudes con la IC y FEVI preservada que reducida. No obstante, la evidencia aún es limitada para que la conclusión sea definitiva." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Camafort Babkowski M. 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Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

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Vol. 217. Issue 5.

Pages 296-298 (June - July 2017)

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