Heart failure with reduced and mid-range ejection fraction: laboratory and instrumental profile
DOI:
https://doi.org/10.18203/2320-6012.ijrms20261670Keywords:
NT-proBNP, Grey zone heart failure, Left ventricular ejection fraction, Mid-range, Quadruple therapyAbstract
Background: Since the publication of the European Society of Cardiology Guidelines for the Diagnosis and Treatment of Heart Failure in 2016, a new class of HF has been defined - HF with mid-range ejection fraction (HFmrEF). Aim of the study was to establish clinical, anamnestic, laboratory and echocardiographic differences in patients with HF with reduced left ventricular ejection fraction (HFrEF) and HFmrEF.
Methods: The retrospective single-center study included 92 patients with HF who were admitted to the Grodno Regional Clinical Cardiological Center for treatment from January 2023 to June 2025. Group 1 included 48 patients with HFrEF (LVEF<40%), while Group 2 included 44 patients with HFmrEF (LVEF 41-49%). We analyzed demographics, comorbidities, treatment, laboratory results, and echocardiographic data.
Results: HFmrEF and HFrEF shared similar age, sex, and major comorbidities (p>0.05), yet displayed distinct clinical and instrumental profiles. HFmrEF showed a milder presentation better NYHA class, fewer pleural effusions, smaller chambers, and markedly lower NT-proBNP whereas HFrEF exhibited advanced remodeling (larger LA/LV dimensions and volumes), more wall-motion abnormalities, thinner systolic septum suggestive of a dilated/ischemic phenotype, higher NT-proBNP, and greater congestion. NT-proBNP level had significant correlations with echocardiographic parameters, including LVEF (R=-0.49, p<0.001).
Conclusions: These findings support: systemic phenotyping of HFmrEF to individualize therapy, broader adoption of SGLT2 inhibitors alongside ARNI optimization and prospective studies to define trajectories, subphenotype-specific responses (e.g. obesity-, ischemia-, AF- driven), and multimodal risk stratification.
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