Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Cardiology, National Heart Centre Singapore, Duke-National University of, Singapore.
Eur J Heart Fail. 2017 Dec;19(12):1569-1573. doi: 10.1002/ejhf.1058. Epub 2017 Oct 24.
The 2016 European Society of Cardiology heart failure guidelines introduced the term 'heart failure with mid-range ejection fraction' (HFmrEF) to refer to patients with heart failure and a mildly reduced ejection fraction of 40-49%. About 20% of heart failure patients fall in this category. One of the main reasons for the introduction of this category was to stimulate research into this grey area. This review aims to highlight the key findings that have been published so far. Firstly, HFmrEF more closely resembles heart failure with reduced (HFrEF) than preserved ejection fraction (HFpEF) with regard to ischaemic aetiology, which is more frequent in both HFmrEF and HFrEF compared to HFpEF. Secondly, changes in ejection fraction over time are common, and seem to be more important than baseline ejection fraction alone. Patients who progress from HFmrEF to HFrEF have a worse prognosis than those who remain stable or transition to HFpEF. Lastly, and perhaps most importantly, retrospective analyses from a randomized trial suggest that patients with HFmrEF seem to benefit from therapies that have shown to improve outcome in HFrEF, whereas no such benefit was seen in patients with HFpEF.
2016 年欧洲心脏病学会心力衰竭指南引入了“射血分数中间值心力衰竭（HFmrEF）”这一术语，用于指代射血分数轻度降低（40%-49%）的心力衰竭患者。约 20%的心力衰竭患者属于这一范畴。引入这一类别主要有一个原因，就是为了推动对这一灰色地带的研究。本篇综述旨在重点介绍迄今为止已发表的关键发现。首先，HFmrEF 在缺血病因学方面与射血分数降低的心力衰竭（HFrEF）更为相似，而不是射血分数保留的心力衰竭（HFpEF），HFmrEF 和 HFrEF 中的缺血性病因比 HFpEF 更为常见。其次，射血分数随时间的变化很常见，似乎比基线射血分数本身更为重要。从 HFmrEF 进展为 HFrEF 的患者预后比那些保持稳定或转为 HFpEF 的患者更差。最后，或许也是最重要的一点，一项随机试验的回顾性分析表明，HFmrEF 患者似乎从已证实可改善 HFrEF 结局的治疗中获益，而 HFpEF 患者则未观察到获益。
