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Clinical phenotype and short-term outcome of acute heart failure in patients with mid-range ejection fraction: a prospective cohort study

Session Poster Session 3

Speaker Selin Atesler

Event : Heart Failure 2019

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

Authors : S Atesler (Metz,FR), N Zannad (Metz,FR), K Khalife (Metz,FR), M Benichou (Metz,FR), C Goetz (Metz,FR), A Olivier (Nancy,FR)

S Atesler1 , N Zannad1 , K Khalife1 , M Benichou1 , C Goetz1 , A Olivier2 , 1Regional hospital Center of Metz-Thionville, Cardiology - Metz - France , 2University Hospital of Nancy - Nancy - France ,


INTRODUCTION: Acute heart failure (AHF) has an unfavourable prognosis in both reduced (HFrEF) and preserved ejection fraction (HFpEF). Current guidelines define heart failure with mid-range ejection fraction (HFmrEF) as a new category to further investigate. Few data are yet available for patients with AHF and mid-range ejection fraction.

PURPOSE : We aimed to define the clinical and biological phenotype, the differences in therapies, the in-hospital management and outcome, and the short-term prognosis of patients hospitalized for AHF with HFmrEF compared to HFrEF and HFpEF. 

METHODS: We include prospectively all consecutive patients hospitalized for AHF in our Heart Failure Unit, between February and December 2017. Clinical and biological phenotype, differences in therapies, in-hospital management and outcome of patients with HFmrEF were compared to HFrEF and HFpEF. The primary endpoint was the composite criteria of all- cause death or heart failure related hospitalization 3 months after discharge. 

RESULTS: From 245 patients included, 102 (41.6%) had HFrEF, 37 (15.1%) HFmrEF, and 106 (43.3%) HFpEF. HFmrEF resembled HFrEF with more ischemic heart disease (55%), lower body mass index (26.2±5.8 kg/m2) and resembled HFpEF with older subjects (80.0±9.0 years) and more hypertension (70%). We found a decreasing gradient of BNP from HFrEF to HFpEF. First line guideline-directed therapies were similarly increased in all groups. Groups were not significantly different for the primary endpoint with 35.0%, 27.5% and 38.0% for HFrEF, HFmrEF and HFpEF respectively (p=0.49) in univariate analysis and neither for the event-free survival in multivariate analysis (p=0.62).  CONCLUSION: HFmrEF patients have a distinct phenotype but a similar adverse short- term prognosis in AHF. Left ventricular ejection fraction solely might be insufficient to assess outcome in AHF. Other variables might be considered.

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