Martone Raffaele, Marchionni Niccolò, Cappelli Francesco
Careggi University Hospital, Cardiovascular and Thoracic Department.
Monaldi Arch Chest Dis. 2019 Apr 8;89(1). doi: 10.4081/monaldi.2019.1024.
Heart failure (HF) with mid-range ejection fraction (HFmrEF) has been conceptualized by the European Society of Cardiology guidelines with the aim of stimulating research to fill a gap in knowledge: whether such a condition exists as a distinct pathophysiological and clinical entity, or it is just a residual category of ejection fraction indeed is still a matter of debate. Current evidence suggests that HFmrEF represents up to one fifth of patients with HF, who may ultimately result in an intermediate clinical phenotype, as for age and gender, with an intermediate prevalence of comorbidities. Nevertheless, a strong connection exists with HF with reduced ejection fraction, since ischemic aetiology is common in both categories, conveying relevant implications for prognosis and therapeutic response. Little is known about its pathophysiology: mild systolic impairment may be not enough and advocating diastolic dysfunction may be an oversimplification. An increasing amount of data is clarifying how many of HFmrEF patients are the results of deteriorating or recovering hearts, thus underscoring that aetiology may be, more than EF, the key to understand this new category. Sparse evidence points toward a potential benefit of common HF therapies in those patients, but further research is still needed.
射血分数中度降低的心力衰竭（HFmrEF）已被欧洲心脏病学会指南纳入概念范畴，目的是推动研究以填补知识空白：这种情况究竟是作为一种独特的病理生理和临床实体存在，还是仅仅是射血分数的一个残余类别，目前仍存在争议。现有证据表明，HFmrEF占心力衰竭患者的五分之一，就年龄和性别而言，这些患者最终可能呈现出一种中间临床表型，合并症的患病率也处于中间水平。然而，它与射血分数降低的心力衰竭存在紧密联系，因为这两类患者中缺血性病因都很常见，这对预后和治疗反应具有重要意义。关于其病理生理学知之甚少：轻度收缩功能障碍可能并不充分，而单纯强调舒张功能障碍可能过于简单化。越来越多的数据正在阐明有多少HFmrEF患者是心脏恶化或恢复的结果，从而突出病因可能比射血分数更是理解这一新类别的关键。少量证据表明常见的心力衰竭治疗方法对这些患者可能有益，但仍需进一步研究。
