Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal - Cardiovascular Imaging, jeac204. https://doi.org/10.1093/ehjci/jeac204 Dr. Louise Brown et al
Points
- A new classification was established by the 2016 European Society of Cardiology Heart Failure Guidelines as heart failure with mid-range ejection fraction ranging from forty to forty-nine percent.
- The lack of proof for this new class was emphasized, and a study into its fundamental traits, pathogenesis, and prognosis was encouraged.
- The cardiac phenotype of the presumed non-ischemic class was defined using cross-cardiac magnetic resonance.
Summary
Individuals with a medical diagnosis of cardiac insufficiency without angina symptoms or a record of a heart attack or cardiac surgery were prospectively included. The total number of participants was 300, and 63% were men. Clinical evaluation and CMR, including T1 mapping, extracellular volume mapping, late gadolinium enhancement, assessment of coronary artery blood flow at rest, and maximum hyperemia, were performed on the participants.
Out of all the participants in the trial, 93 came up with heart failure with preserved ejection fraction, 46 with mid-range ejection fraction, and 134 had cardiac failure with decreased ejection fraction. Moreover, there was proof of occult ischemic heart disease in 19 individuals with mid-range ejection fraction.
Diffuse fibrosis and hyperemic cardiac blood circulation were identical across preserved ejection fraction and reduced ejection fraction. However, reduced ejection fraction had substantially lower native T1, ECV, and high myocardial perfusion reserve compared to preserved ejection fraction.
Individuals with reduced ejection fraction had a greater incidence of hidden coronary artery disease. Still, they shared most clinical features with preserved ejection fraction, such as endothelial damage and scarring. Confirming how the phenotypic of reduced ejection fraction reacts to medical treatment requires more research.
Reduce ejection fraction patients’ age and gender pattern was similar to that of preserved ejection fraction patients. However, there were no appreciable variations in cardiac risk factors between reduced ejection fraction sufferers and other groups.
Co-morbidities were identical between the categories. In terms of functional class, there was no distinction between the groups. Respiratory symptoms were described by reduced ejection fraction sufferers in a similar proportion to preserved ejection fraction patients but less frequently than the sufferers of reduced ejection fraction. Lastly, the effectiveness of mineralocorticoid antagonist and diuretic treatment appeared best in reduced ejection fraction and lowest in preserved ejection fraction category.
Link to the article: https://academic.oup.com/ehjcimaging/advance-article/doi/10.1093/ehjci/jeac204/6774450
References Brown, L. A. E., Wahab, A., Ikongo, E., Saunderson, C. E. D., Jex, N., Thirunavukarasu, S., Chowdhary, A., Das, A., Craven, T. P., Levelt, E., Dall’Armellina, E., Knott, K. D., Greenwood, J. P., Moon, J. C., Xue, H., Kellman, P., Plein, S., & Swoboda, P. P. (2022). Cardiovascular magnetic resonance phenotyping of heart failure with mildly reduced ejection fraction. European Heart Journal - Cardiovascular Imaging, jeac204. https://doi.org/10.1093/ehjci/jeac204
