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The continuous heart failure spectrum: moving beyond an ejection fraction classification.

Authors :
Triposkiadis F
Butler J
Abboud FM
Armstrong PW
Adamopoulos S
Atherton JJ
Backs J
Bauersachs J
Burkhoff D
Bonow RO
Chopra VK
de Boer RA
de Windt L
Hamdani N
Hasenfuss G
Heymans S
Hulot JS
Konstam M
Lee RT
Linke WA
Lunde IG
Lyon AR
Maack C
Mann DL
Mebazaa A
Mentz RJ
Nihoyannopoulos P
Papp Z
Parissis J
Pedrazzini T
Rosano G
Rouleau J
Seferovic PM
Shah AM
Starling RC
Tocchetti CG
Trochu JN
Thum T
Zannad F
Brutsaert DL
Segers VF
De Keulenaer GW
Source :
European heart journal [Eur Heart J] 2019 Jul 01; Vol. 40 (26), pp. 2155-2163.
Publication Year :
2019

Abstract

Randomized clinical trials initially used heart failure (HF) patients with low left ventricular ejection fraction (LVEF) to select study populations with high risk to enhance statistical power. However, this use of LVEF in clinical trials has led to oversimplification of the scientific view of a complex syndrome. Descriptive terms such as 'HFrEF' (HF with reduced LVEF), 'HFpEF' (HF with preserved LVEF), and more recently 'HFmrEF' (HF with mid-range LVEF), assigned on arbitrary LVEF cut-off points, have gradually arisen as separate diseases, implying distinct pathophysiologies. In this article, based on pathophysiological reasoning, we challenge the paradigm of classifying HF according to LVEF. Instead, we propose that HF is a heterogeneous syndrome in which disease progression is associated with a dynamic evolution of functional and structural changes leading to unique disease trajectories creating a spectrum of phenotypes with overlapping and distinct characteristics. Moreover, we argue that by recognizing the spectral nature of the disease a novel stratification will arise from new technologies and scientific insights that will shape the design of future trials based on deeper understanding beyond the LVEF construct alone.<br /> (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Details

Language :
English
ISSN :
1522-9645
Volume :
40
Issue :
26
Database :
MEDLINE
Journal :
European heart journal
Publication Type :
Academic Journal
Accession number :
30957868
Full Text :
https://doi.org/10.1093/eurheartj/ehz158