Clinical and echocardiographic features in patients with different phenotypes of heart failure
DOI:
https://doi.org/10.18203/2320-6012.ijrms20261319Keywords:
Left ventricular ejection fraction, Hypertension, NT-proBNP, Heart failure with reduced ejection fraction, Heart failure with mid-range ejection fractionAbstract
Background: Despite the advancements in heart failure (HF) management, a gap remains in distinguishing the clinical and echocardiographic profiles among the different phenotypes of HF, particularly in HF with mid-range ejection fraction (HFmrEF). The aim of the current study was to establish clinical and echocardiographic differences in patients with HF with reduced and mid-range left ventricular ejection fraction (LVEF).
Methods: The study included 80 patients with chronic HF with LVEF less than 50% who were divided into two groups: HF with reduced ejection fraction (HFrEF) (n=45) and HFmrEF (n=35). All patients underwent clinical, laboratory, and instrumental studies, including transthoracic echocardiography. Statistical analysis was performed using «STATISTICA 12.0».
Results: Patients of both groups were predominantly male (p>0.05), comparable in age prevalence of atrial fibrillation and diabetes mellitus (p>0.05). Patients with HFmrEF more often suffered from hypertension (p=0.04) and stable angina class 3 (p=0.010). Laboratory markers in both groups had no significant differences except for NT-proBNP levels (p=0.031), which were higher in patients with HFrEF. Patients with HFrEF had higher linear and volumetric parameters of both atria and ventricles (p<0.05), which demonstrated undeniable correlation between LVEF and other heart diameters and volumes.
Conclusions: Our study showed that patients with HFmrEF have significant differences from HFrEF (higher incidence of hypertension, lower NYHA class and NT-proBNP levels). This highlights that the further study of clinical and laboratory characteristics of HFmrEF should be conducted.
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References
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines,” Circulation. 2022;145(18):e895-1032. DOI: https://doi.org/10.1161/CIR.0000000000001073
Kemp CD, Conte JV. The pathophysiology of heart failure. Cardiovascular Pathol. 2012;21(5):365-71. DOI: https://doi.org/10.1016/j.carpath.2011.11.007
Shams P, Malik A, Chhabra L. Congestive Heart Failure. StatPearls. Treasure Island (FL): StatPearls Publishing. 2026.
Kotzé A, Howell SJ. Heart failure: pathophysiology, risk assessment, community management and anaesthesia. Continuing Educat Anaesthesia Critical Care Pain. 2008;8(5):161-6. DOI: https://doi.org/10.1093/bjaceaccp/mkn028
Caraballo C, Desai NR, Mulder H, Alhanti B, Wilson FP, Fiuzat M, et al. Clinical Implications of the New York Heart Association Classification. J Am Heart Assoc. 2019;8(23):e014240. DOI: https://doi.org/10.1161/JAHA.119.014240
Xanthopoulos A, Giamouzis G, Skoularigis J, Triposkiadis F. Heart failure with reduced, mildly reduced, or preserved left ventricular ejection fraction: Has reasoning been lost? World J Cardiol. 2022;14:438. DOI: https://doi.org/10.4330/wjc.v14.i7.438
Ibrahim NE, Song Y, Cannon CP, Doros G, Russo P, Ponirakis A, et al. Heart failure with mid-range ejection fraction: Characterization of patients from the PINNACLE registry(R). ESC Heart Fail. 2019;6(4):784-92. DOI: https://doi.org/10.1002/ehf2.12455
Savarese G, Vasko P, Jonsson Å, Edner M, Dahlström U, Lund LH. The Swedish Heart Failure Registry: a living, ongoing quality assurance and research in heart failure. Ups J Med Sci. 2019;124(1):65-9. DOI: https://doi.org/10.1080/03009734.2018.1490831
Streng KW, Nauta JF, Hillege HL, Anker SD, Cleland JG, Dickstein K, et al. Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction. Int. J. Cardiol. 2018;271:132-9. DOI: https://doi.org/10.1016/j.ijcard.2018.04.001
Gomez-Otero I, Ferrero-Gregori A, Varela Roman A, Seijas Amigo J, Pascual-Figal DA, Delgado Jimenez J. Mid-range ejection fraction does not permit risk stratification among patients hospitalized forheart failure. Rev Esp Cardiol. 2017;70(5):338-46. DOI: https://doi.org/10.1016/j.rec.2016.11.016
Branca L, Sbolli M, Fudim M. Heart failure with mid-range ejection fraction: Pro and cons of the new classification of Heart Failure by European Society of Cardiology guidelines. ESC Heart Fail. 2020;7(2):381-99. DOI: https://doi.org/10.1002/ehf2.12586
Rickenbacher P, Kaufmann BA, Maeder MT, Bernheim A, Goetschalckx K, Pfister O, et al. Heart failure with mid-range ejection fraction: a distinct clinical entity? Insights from the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF). Eur J Heart Fail. 2017;19(12):1586-96. DOI: https://doi.org/10.1002/ejhf.798
Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T, et al. Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 study. Eur J Heart Fail. 2017;19(10):1258-69. DOI: https://doi.org/10.1002/ejhf.807
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