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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).
- Source :
-
European Journal of Heart Failure . Dec2017, Vol. 19 Issue 12, p1586-1596. 11p. 6 Charts, 2 Graphs. - Publication Year :
- 2017
-
Abstract
- <bold>Aims: </bold>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.<bold>Methods and Results: </bold>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.<bold>Conclusion: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CONGESTIVE heart failure treatment
*VENTRICULAR ejection fraction
*EPIDEMIOLOGY
*DISEASE prevalence
*OLDER patients
*LEFT heart ventricle
*HEART physiology
*HEART failure treatment
*CARDIOVASCULAR agents
*COMPARATIVE studies
*ECHOCARDIOGRAPHY
*LONGITUDINAL method
*HEART failure
*RESEARCH methodology
*MEDICAL cooperation
*PROGNOSIS
*RESEARCH
*DISEASE management
*EVALUATION research
*STROKE volume (Cardiac output)
*DIAGNOSIS
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 13889842
- Volume :
- 19
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- European Journal of Heart Failure
- Publication Type :
- Academic Journal
- Accession number :
- 127025883
- Full Text :
- https://doi.org/10.1002/ejhf.798