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Clinical characteristics and long-term outcomes of patients with acute decompensated heart failure with mid-range ejection fraction

Session Poster Session 3

Speaker Miyuki Ito

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : M Ito (Saitama,JP), H Wada (Saitama,JP), T Ibe (Saitama,JP), Y Ugata (Saitama,JP), K Sakakura (Saitama,JP), H Fujita (Saitama,JP), S Momomura (Saitama,JP)

M Ito1 , H Wada1 , T Ibe1 , Y Ugata1 , K Sakakura1 , H Fujita1 , S Momomura1 , 1Jichi Medical University Saitama Medical Center, Cardiology - Saitama - Japan ,



Patients with HF have been categorized to HFrEF and HFpEF. There were distinct differences in demography, etiology, comorbidities and response to therapies between HFrEF and HFpEF. In HFrEF, most of previous reports included patients with LVEF <35% to <40%. However, in HFpEF, various cutoffs of LVEF were used in previous studies (LVEF >40% to >50%). Consequently, patients with a LVEF in the range of 40-49% is considered "grey area". Recently, the clinical guidelines categorized patients with LVEF in the range of 40-49% as HF with "mid-range" ejection fraction (HFmrEF).


The purpose of this study was to investigate the clinical characteristics and long-term outcomes of HFmrEF patients.


This was a single-center retrospective observational study. We examined the clinical characteristics and outcomes of consecutive 494 acute decompensated heart failure (ADHF) patients who admitted to our institution between January 2014 and December 2016. They were divided into three groups according to their LVEF: HFrEF (LVEF < 40%), HFmrEF (LVEF 40-49%), and HFpEF (LVEF = 50%). The primary endpoint of this study was the composite of cardiovascular death and HF readmission.


Of this population, 282 (57.1%), 75 (15.2%) and 137 (48.6%) patients were HFrEF, HFmrEF and HFpEF, respectively. Ischemic heart disease was the primary etiology in HFmrEF and HFrEF. At the time of discharge, beta-blockers and renin-angiotensin system inhibitors (RASI) were more frequently prescribed in HFmrEF than HFpEF. The composite outcome of cardiovascular mortality and HF readmission was significantly lower in HFmrEF than HFrEF.


The prevalence of ischemic etiology in HFmrEF was higher than HFpEF. The cardiovascular prognosis of HFmrEF was better compared with HFrEF. Further studies are needed to determine the effectiveness of management of coronary artery disease and cardioprotective medications for HFmrEF.

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