Clinical characteristics and prognosis of heart failure with mid-range ejection fraction: insights from a multi-centre registry study in China

• Published in: BMC cardiovascular disorders Vol. 19; no. 1; p. 209
• Main Authors: Lyu, Siqi, Yu, Litian, Tan, Huiqiong, Liu, Shaoshuai, Liu, Xiaoning, Guo, Xiao, Zhu, Jun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.09.2019; BioMed Central; BMC
• Subjects: Analysis; Angioplasty; Cardiovascular diseases; Care and treatment; Congestive heart failure; Coronary artery disease; Echocardiography; Ejection fraction; Etiology; Etiology (Medicine); Evidence-based medicine; Evidence-based practice; Health risk assessment; Heart attack; Heart diseases; Heart failure; Implants; Ischemia; Ischemic heart disease; Medical research; Mid-range ejection fraction; Mortality; Multivariate analysis; Myocardial infarction; Myocardial ischemia; Prognosis; China; Heart failure; Ischemic heart disease; Prognosis; Mid-range ejection fraction
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-019-1177-1

Heart failure (HF) with mid-range ejection fraction (EF) (HFmrEF) has attracted increasing attention in recent years. However, the understanding of HFmrEF remains limited, especially among Asian patients. Therefore, analysis of a Chinese HF registry was undertaken to explore the clinical characteristics and prognosis of HFmrEF. A total of 755 HF patients from a multi-centre registry were classified into three groups based on EF measured by echocardiogram at recruitment: HF with reduced EF (HFrEF) (n = 211), HFmrEF (n = 201), and HF with preserved EF (HFpEF) (n = 343). Clinical data were carefully collected and analyzed at baseline. The primary endpoint was all-cause mortality and cardiovascular mortality while the secondary endpoints included hospitalization due to HF and major adverse cardiac events (MACE) during 1-year follow-up. Cox regression and Logistic regression were performed to identify the association between the three EF strata and 1-year outcomes. The prevalence of HFmrEF was 26.6% in the observed HF patients. Most of the clinical characteristics of HFmrEF were intermediate between HFrEF and HFpEF. But a significantly higher ratio of prior myocardial infarction (p = 0.002), ischemic heart disease etiology (p = 0.004), antiplatelet drug use (p = 0.009), angioplasty or stent implantation (p = 0.003) were observed in patients with HFmrEF patients than those with HFpEF and HFrEF. Multivariate analysis showed that the HFmrEF group presented a better prognosis than HFrEF in all-cause mortality [p = 0.022, HR (95%CI): 0.473(0.215-0.887)], cardiovascular mortality [p = 0.005, HR (95%CI): 0.270(0.108-0.672)] and MACE [p = 0.034, OR (95%CI): 0.450(0.215-0.941)] at 1 year. However, no significant differences in 1-year outcomes were observed between HFmrEF and HFpEF. HFmrEF is a distinctive subgroup of HF. The strikingly prevalence of ischemic history among patients with HFmrEF might indicate a key to profound understanding of HFmrEF. Patients in HFmrEF group presented better 1-year outcomes than HFrEF group. The long-term prognosis and optimal medications for HFmrEF require further investigations.