Heart failure with mid-range left ventricular ejection fraction (HFmrEF) in the CHART-2 Study

What is it about?

The new category of heart failure (HF), HF with mid-range left ventricular ejection fraction (LVEF) (HFmrEF), has been recently proposed. However, the clinical features of HFmrEF, with a reference to HF with preserved LVEF (HFpEF) and HF with reduced LVEF (HFrEF) in the same HF cohort, remain to be fully examined. In the present study, we examined the characteristics and outcomes of HFmrEF patients registered in our CHART-2 Study, which is the largest prospective observational study for stable CHF in Japan. Our results clearly demonstrate that (1) clinical characteristics and prognostic factors of HFmrEF are intermediate between HFpEF and HFrEF, (2) there are important LVEF transitions in HFmrEF and HFrEF, especially within one year after registration, whereas HFpEF largely remaines in HFpEF, (3) prognosis of HFmrEF resembles that of HFpEF, while the prognostic impact of cardiovascular medications in HFmrEF resembles that in HFrEF, and (4) HFmrEF is associated with worse prognosis only when transitions to HFrEF.

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Why is it important?

To the best of our knowledge, this is the first large-scale prospective observational study that examined the clinical features of HFmrEF, with a reference to HFpEF and HfrEF, in the same HF cohort. Our results suggest that HFmrEF is a transitional stage from HFpEF to HFrEF, or from HFrEF to HFpEF, or an overlap zone of HFpEF with lower-end LVEF and HFrEF with higher-end LVEF, rather than a distinct entity from of HF. This finding would help to address the knowledge gap in the understanding of HFmrEF in the current clinical guidelines.