Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
JACC Heart Fail. 2017 Nov;5(11):763-771. doi: 10.1016/j.jchf.2017.06.013. Epub 2017 Oct 11.
Heart failure (HF) with borderline ejection fraction was first defined in 2013 in the American College of Cardiology/American Heart Association guidelines as the presence of the typical symptoms of HF and a left ventricular ejection fraction (LVEF) of 41% to 49%. In 2016, the European Society of Cardiology specified HF with mid-range ejection fraction (HFmrEF) as LVEF of 40% to 49%. This range of LVEF is less well studied compared with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). Although there are effective, guideline-directed medical therapies for patients with HFrEF, no therapies thus far show measurable benefit in HFpEF. Patients with HFmrEF have a clinical profile and prognosis that are closer to those of patients with HFpEF than those of HFrEF, with certain distinctions. Whether these patients represent a unique and dynamic HF group that may benefit from targeted therapies known to be beneficial in patients with HFrEF, such as neurohormonal blockade, requires further study. This review summarizes what is known about the clinical epidemiology, pathophysiology, and prognosis for patients with HFmrEF and how these features compare with the more well-studied HF groups. Although recommended treatments currently focus on aggressive management of comorbidities, we summarize the studies that identify a potential signal for beneficial therapies. Future studies are needed to not only better characterize the HFmrEF population but to also determine effective management strategies to reduce the high cardiovascular morbidity and mortality burden on this phenotype of patients with HF.
心力衰竭（HF）伴临界射血分数于 2013 年首次在《美国心脏病学会/美国心脏协会指南》中定义，其具有心力衰竭的典型症状和左心室射血分数（LVEF）为 41%至 49%。2016 年，欧洲心脏病学会将射血分数中间范围的心力衰竭（HFmrEF）定义为 LVEF 为 40%至 49%。与射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）相比，这个 LVEF 范围的研究较少。尽管 HFrEF 患者有有效的、指南指导的医学治疗方法，但迄今为止，没有治疗方法在 HFpEF 中显示出可衡量的益处。HFmrEF 患者的临床特征和预后与 HFpEF 患者更为接近，而与 HFrEF 患者则有所不同。这些患者是否代表了一个独特的、动态的心力衰竭群体，可能受益于已知对 HFrEF 患者有益的靶向治疗，如神经激素阻断，需要进一步研究。本综述总结了 HFmrEF 患者的临床流行病学、病理生理学和预后，以及这些特征与更为成熟的心力衰竭群体的比较。尽管目前推荐的治疗方法侧重于积极管理合并症，但我们总结了一些识别潜在有益治疗方法的研究。未来的研究不仅需要更好地描述 HFmrEF 人群，还需要确定有效的管理策略，以降低这种心力衰竭表型患者的心血管发病率和死亡率负担。
