Heart Failure And Ejection Fraction
Said Hajouli, Dipesh Ludhwani
Abstract
Heart failure (HF) is a complex clinical syndrome that results from either functional or structural impairment of ventricles resulting in symptomatic left ventricle (LV) dysfunction. The symptoms come from an inadequate cardiac output, failing to keep up with the metabolic demands of the body. It is a leading cause of cardiovascular morbidity and mortality worldwide despite the advances in therapies and prevention. It can result from disorders of the pericardium, myocardium, endocardium, heart valves, great vessels, or some metabolic abnormalities. Definition Three main phenotypes describe HF according to the measurement of the left ventricle ejection fraction (EF), and the differentiation between these types is important due to different demographics, co-morbidities, and response to therapies: Heart failure with reduced ejection fraction (HFrEF): EF less than or equal to 40% Heart failure with preserved EF (HFpEF): EF is greater than or equal to 50% Heart failure with mid-range EF (HFmrEF) (other names are: HFpEF-borderline and HFpEF-improved when EF in HFrEF improves to greater than 40%): EF is 41% to 49% per European guidelines and 40 to 49% per the US guidelines. A new class of HF that introduced by the 2016 European Society of Cardiology (ESC) guidelines for diagnosis and management of HF. This class was known as the grey area between the HFpEF and HFrEF and now has its distinct entity by giving it a name as HFmrEF. All patients with HFrEF have concomitant diastolic dysfunction; in contrast, diastolic dysfunction may occur in the absence of systolic dysfunction.