Heart failure with supra‐normal left ventricular ejection fraction: distinct polygenic bases of an unrecognized phenotype.

B This article refers to 'Genetic and phenotypic profiling of supranormal ejection fraction reveals decreased survival and underdiagnosed heart failure' by I.S. Forrest I et al i ., published in this issue on pages 2118-2127. b In the last years, a fourth category of heart failure (HF), characterized by supra-normal left ventricular ejection fraction (LVEF) >65% (snLVEF), termed HF with snLVEF (HFsnEF), made its debut in the clinical arena. Other unknown features, however, may characterize patients with snLVEF, as HF medications, when present, only mildly attenuate the association with mortality.[6] Clinical cardiologists in fact may not feel themselves at ease when trying to identify these patients among those normally encountered in a HF clinic. Both snLVEF patients and snLVEF-GRS were associated with HF symptoms and medications, and elevated HF biomarkers, but not with HF diagnosis, supporting the hypothesis of its underdiagnosis. [Extracted from the article]