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Profile and differential management of patients with a mid-range ejection fraction compared to patients with depressed ejection fraction, long-term follow-up

Session Poster Session 3

Speaker Daniel Enriquez Vazquez

Event : Heart Failure 2019

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

Authors : D Enriquez Vazquez (Madrid,ES), CN Perez Garcia (Madrid,ES), M Ferrandez Escarabajal (Madrid,ES), TS Luque Diaz (Madrid,ES), A Travieso Gonzalez (Madrid,ES), M Perez Serrano (Madrid,ES), C Olmos Blanco (Madrid,ES), D Vivas Balcones (Madrid,ES), E Martinez Gomez (Madrid,ES), J Higueras Nafria (Madrid,ES), R Bover Freire (Madrid,ES), J Goirigolzarri (Madrid,ES), I Vilacosta (Madrid,ES), C Macaya (Madrid,ES)

Authors:
D Enriquez Vazquez1 , CN Perez Garcia1 , M Ferrandez Escarabajal1 , TS Luque Diaz1 , A Travieso Gonzalez1 , M Perez Serrano1 , C Olmos Blanco1 , D Vivas Balcones1 , E Martinez Gomez1 , J Higueras Nafria1 , R Bover Freire1 , J Goirigolzarri1 , I Vilacosta1 , C Macaya1 , 1Hospital Clinic San Carlos, Cardiovascular Institute - Madrid - Spain ,

Citation:

Introduction
Heart failure (HF) with midrange ejection fraction (EFmr) rises as a differential group.

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

Methods
Patients with a diagnosis of HF admitted to a Cardiology Service of a tertiary hospital between July 2016 and March 2017 have been collected prospectively and consecutively, and their follow up.

Results
Of the total of 341 patients collected, 49 patients had EFmr (40-49%) and 114 patients with EFr (<40%). The median follow-up was 403 days. The baseline characteristics are in Table 1. Patients with EFmr have a generally poorer cardiovascular risk profile, and more often have tachyarrhythmias or acute ischemic heart disease as triggers.

More beta-blockers were used at discharge in patients with EFr (83.8% vs 73.5%) without reaching statistical significance. The use of ACEi or ARA2 is similar (65% in both cases), but in the EFmr group, 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 EFr (65% vs 30% at discharge, p <0.001). The use of diuretics at discharge was higher in the group of patients with EFr than in the EFmr group (82% vs 69.4%), p 0.07).

In the long-term follow-up, patients with EFmr are admitted for different causes than the HF in a greater percentage, without reaching statistical significance (15.6% vs 8.6% at 6 months and 26.2% vs 18.6 % in more than one year, NS). No significant differences were found in terms of mortality due to HF or all causes.

Conclusions
The patient with EFmr who is admitted for HF mainly due to tachyarrhythmias or acute ischemic heart disease. They also have less right ventricular dysfunction. Diuretics are used in smaller amounts, as well as ARMs. In long-term follow-up, a higher percentage of readmissions due to causes other than HF was observed in this subgroup.

Characteristic

Midrange EF

Reduced EF

p value

Mean age

77,0

71,7

0,002

Sex female

36,7%

23%

0,066

Hypertension

87,8%

75,2%

0,072

Smoker

6,1%

15%

0,117

Ischemic cardiopathy as trigger

20,4%

10,6%

0,095

Tachyarrythmia as trigger

26,5%

15,2%

0,089

Mean EF (%)

44,8%

27,6%

<0,001

Right ventricle disfunction

16,3%

43,2%

<0,001

Table 1

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