TY - JOUR
T1 - Heart failure with mid-range ejection fraction
T2 - a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF)
AU - Rickenbacher, Peter
AU - Kaufmann, Beat A.
AU - Maeder, Micha T.
AU - Bernheim, Alain
AU - Goetschalckx, Kaatje
AU - Pfister, Otmar
AU - Pfisterer, Matthias
AU - Brunner-La Rocca, Hans-Peter
AU - Investigators, TIME-CHF
PY - 2017/12
Y1 - 2017/12
N2 - Aims While the conditions of heart failure (HF) with reduced (HFrEF, LVEF <40%) and preserved (HFpEF, LVEF >= 50%) left ventricular ejection fraction (LVEF) are well characterized, it is unknown whether patients with HF and mid-range LVEF (HFmrEF, LVEF 40-49%) have to be regarded as a separate clinical entity. The aim of this study was to characterize these three populations and to compare outcome and response to therapy.Methods and results The analysis was based on the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) comprising a population with established HF including the whole spectrum of LVEF. Of the 622 patients, 108 (17%) were classified as having HFmrEF. This group was in general found to be 'intermediate' regarding clinical characteristics with a comparable and high burden of comorbidities and equally impaired quality of life but was more likely to have coronary artery disease as compared with the HFpEF group. During a median follow-up of 794 days, mortality was 39.7% without significant differences between groups. N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided as compared with standard therapy resulted in improved survival free of HF hospitalizations in HFrEF and HFmrEF, but not in HFpEF.Conclusion Although the 'intermediate' clinical profile of HFmrEF between HFrEF and HFpEF would support the conclusion that HFmrEF is a distinct clinical entity, we hypothesize that HFmrEF has to be categorized as HFrEF because of the high prevalence of coronary artery disease and the similar benefit of NT-proBNP-guided therapy in HFrEF and HFmrEF, in contrast to HFpEF.
AB - Aims While the conditions of heart failure (HF) with reduced (HFrEF, LVEF <40%) and preserved (HFpEF, LVEF >= 50%) left ventricular ejection fraction (LVEF) are well characterized, it is unknown whether patients with HF and mid-range LVEF (HFmrEF, LVEF 40-49%) have to be regarded as a separate clinical entity. The aim of this study was to characterize these three populations and to compare outcome and response to therapy.Methods and results The analysis was based on the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) comprising a population with established HF including the whole spectrum of LVEF. Of the 622 patients, 108 (17%) were classified as having HFmrEF. This group was in general found to be 'intermediate' regarding clinical characteristics with a comparable and high burden of comorbidities and equally impaired quality of life but was more likely to have coronary artery disease as compared with the HFpEF group. During a median follow-up of 794 days, mortality was 39.7% without significant differences between groups. N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided as compared with standard therapy resulted in improved survival free of HF hospitalizations in HFrEF and HFmrEF, but not in HFpEF.Conclusion Although the 'intermediate' clinical profile of HFmrEF between HFrEF and HFpEF would support the conclusion that HFmrEF is a distinct clinical entity, we hypothesize that HFmrEF has to be categorized as HFrEF because of the high prevalence of coronary artery disease and the similar benefit of NT-proBNP-guided therapy in HFrEF and HFmrEF, in contrast to HFpEF.
KW - Heart failure
KW - Heart failure with reduced ejection fraction
KW - Heart failure with preserved ejection fraction
KW - Heart failure with mid-range ejection fraction
KW - Prognosis
KW - CORONARY-ARTERY-DISEASE
KW - SYSTOLIC FUNCTION
KW - TASK-FORCE
KW - OUTCOMES
KW - ASSOCIATION
KW - MANAGEMENT
KW - LESS-THAN-40-PERCENT
KW - ECHOCARDIOGRAPHY
KW - SPIRONOLACTONE
KW - 55-PERCENT
U2 - 10.1002/ejhf.798
DO - 10.1002/ejhf.798
M3 - Article
C2 - 28295985
SN - 1388-9842
VL - 19
SP - 1586
EP - 1596
JO - European journal of heart failure
JF - European journal of heart failure
IS - 12
ER -