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Profile and differential management of patients with a mid-range ejection fraction compared to patients with reduced ejection fraction

Session Poster Session 3

Speaker Daniel Enriquez Vazquez

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Heart Failure with Mid-range Ejection Fraction
  • Session type : Poster Session

Authors : D Enriquez Vazquez (Madrid,ES), C Perez Garcia (Madrid,ES), TS Luque Diaz (Madrid,ES), A Travieso Gonzalez (Madrid,ES), V Ruiz Pizarro (Madrid,ES), C Olmos Blanco (Madrid,ES), D Vivas Balcones (Madrid,ES), P Martinez Santos (Madrid,ES), M Perez Serrano (Madrid,ES), R Bover Freire (Madrid,ES), I Vilacosta (Madrid,ES), C Macaya (Madrid,ES)

D Enriquez Vazquez1 , C Perez Garcia1 , TS Luque Diaz1 , A Travieso Gonzalez1 , V Ruiz Pizarro1 , C Olmos Blanco1 , D Vivas Balcones1 , P Martinez Santos1 , M Perez Serrano1 , R Bover Freire1 , I Vilacosta1 , C Macaya1 , 1Hospital Clinic San Carlos, Cardiovascular Institute - Madrid - Spain ,


In European Society of Cardiology guidelines on the diagnosis and management of patients with heart failure (HF), a new door opens to that gray area corresponding to patients with ejection fraction (EF) between 40-49%. These are framed within a new group known as mid-range ejection fraction (HFmrEF). 

The objective of this study is to characterize this type of patients and their comparison with heart failure with reduced EF (HFrEF).

Patients diagnosed with HF admitted to a Cardiology Service of a tertiary hospital between July 2016 and March 2017 were registered prospectively and consecutively for one year.

Of the total of 341 patients, 90 patients had HFmrEF and 113 patients with HFrEF. Baseline characteristics of both groups of patients are shown in Table 1. Patients with HFmrEF have a generally poorer cardiovascular risk profile, and more often tachyarrhythmias or acute ischemic heart disease as triggers.

Beta-blockers were used at discharge in higher proportion in patients with HFrEF (83.8% vs 73.5%). The percentage of use of ACE inhibitors or ARA2 is similar between the two groups (65%), but in HFmrEF, ARA2 was used in a higher percentage (20, 4% vs 8.1%, p 0.027). MRAs are used in both groups, with greater use in patients with HFrEF (65% vs 30% at discharge, p <0.001). The use of diuretics at discharge was higher in the group of patients with HFrEF than in the mid-range group (82% vs 69.4%, p 0.07).

HFmrEF patient presents higher cardiovascular risk, with admissions for heart failure mainly due to tachyarrhythmias or acute ischemic heart disease. They also have less right ventricular dysfunction. Diuretics are used in smaller quantities, as well as ARMs, and to a greater extent the ARA2.




p value
Mean age (yr) 77 71.7 0.002
Male sex 36% 23% 0.071
Hypertension 87.8% 75.2% 0.07
Alcohol consumption 4.1% 14.2% 0.06
NTproBNP at admission 8426 12005 0.06
Trigger: ICM 20.4% 10.6% 0.09
Trigger: TA 26.5% 15.2% 0.08
Mean EF 44.8% 27.6% 0.001
RVD 16.3% 43.2%


ICM ischaemic cardiomyopathy. TA tachyarrythmia. RVD right ventricle dysfunction.

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