https://doi.org/10.4081/acbr.2021.150
Clinical characteristics and correlates of patients with heart failure with mid-range ejection fraction in southwest Nigeria
Submitted: 13 June 2021
Accepted: 10 September 2021
Published: 13 October 2021
Accepted: 10 September 2021
Abstract Views: 433
PDF: 154
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
A new class of Heart Failure (HF) phenotypes, HF with midrange Ejection Fraction (HFmrEF), was recently introduced, but its clinical characteristics and therapeutic distinctiveness are not yet well understood. This study aimed to describe the clinical characteristics, echocardiographic features, and other correlates of HFmrEF in southwest Nigeria. Two hundred and sixty-nine consecutive HF subjects who had echocardiography done in the cardiology clinics of two teaching hospitals were recruited for this study. Clinical parameters such as age, body mass index, waist-hip ratio, and gender were determined. The presence of comorbidities, such as hypertension and diabetes, was also assessed. Statistical analysis was done, and p <0.05 was taken as statistically significant. HFmrEF subjects constituted 27.5% of total cohort, while subjects with HF with preserved Ejection Fraction (HFpEF) and HF with reduced Ejection Fraction (HFrEF) were 29.0% and 43.5% respectively. HFmrEF was more likely to be associated with high systolic blood pressure and obesity. The clinical characteristics of HFmrEF were intermediate between those of the other two HF phenotypes. Prevalence of comorbidities, such as anaemia, iron deficiency, pulmonary hypertension, and left ventricular hypertrophy were also intermediate between HFpEF and HFrEF. Atrial fibrillation was commonest among HFmrEF subjects. There was no significant age or gender variation between the three phenotypes. Patients with HFmrEF have clinical and demographic distinctiveness that are often intermediate between HFpEF and HFrEF phenotypes. Further studies of this HF phenotype will help in understanding its therapeutic identity and its prognosis among Africans.
Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 2016. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129–2200.
Casey JDE, Colvin MM, Drazner MH, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 2016;68:1476–88.
DOI: https://doi.org/10.1016/j.jacc.2016.05.011
Solomon SD, Anavekar N, Skali H, et al. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 2005;112:3738–3744.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.561423
Coles AH, Fisher K, Darling C, et al. Long-term survival for patients with acute decompensated heart failure according to ejection fraction findings. Am J Cardiol 2014;114:862–8.
DOI: https://doi.org/10.1016/j.amjcard.2014.06.017
Hsu JJ, Ziaeian B, Fonarow GC. Heart failure with mid-range (borderline) ejection fraction: Clinical implications and future directions. JACC Heart Fail 2017;5:763-71.
DOI: https://doi.org/10.1016/j.jchf.2017.06.013
Lopatin Y. Heart failure with mid-range ejection fraction and how to treat it. Card Fail Rev 2018;4:9-13.
DOI: https://doi.org/10.15420/cfr.2018:10:1
Lauritsen J, Gustafsson F, Abdulla J. Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail 2018;5:685-94.
DOI: https://doi.org/10.1002/ehf2.12283
Mesquita ET, Barbetta LMDS, Correia ETO. Heart failure with mid-range ejection fraction - state of the art. Arq Bras Cardiol 2019;112:784-90.
DOI: https://doi.org/10.5935/abc.20190079
Nadar SK, Tariq O. What is heart failure with mid-range ejection fraction? A new subgroup of patients with heart failure. Card Fail Rev 2018;4:6-8.
DOI: https://doi.org/10.15420/cfr.2018:7:2
Tsuji K, Sakata Y, Nochioka K, et al. Characterization of heart failure patients with mid-range left ventricular ejection fraction—a report from the CHART-2 Study. Eur J Heart Fail 2017;19:1258–69.
DOI: https://doi.org/10.1002/ejhf.807
Triposkiadis F, Butler J, Abboud FM, et al. The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur Heart J 2019;40:2155–63.
Kao DP, Lewsey JD, Anand IS, et al. Characterization of subgroups of heart failure patients with preserved ejection fraction with possible implications for prognosis and treatment response. Eur J Heart Fail 2015;17:925–935.
DOI: https://doi.org/10.1002/ejhf.327
Rickenbacher P, Kaufmann BA, Maeder MT, et al. For the TIME-CHF Investigators. Heart failure with mid-range ejection fraction: a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF). Eur J Heart Fail 2017;19:1586–96.
DOI: https://doi.org/10.1002/ejhf.798
Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J 2012;33:1750–7.
DOI: https://doi.org/10.1093/eurheartj/ehr254
Hernandez AF, Hammill BG, O’Connor CM, et al. Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol 2009;53:184–92.
DOI: https://doi.org/10.1016/S0145-4145(09)79478-X
Dharmarajan K, Rich MW. Epidemiology, pathophysiology and prognosis of heart failure in older adults. Heart Fail Clin 2017;13:417-26.
DOI: https://doi.org/10.1016/j.hfc.2017.02.001
Biglane JB, Becnel MF, Ventura HO, Krim SR. Pharmacologic therapy for heart failure with reduced ejection fraction: Closing the gap between clinical guidelines and practice. Prog Cardiovasc Dis 2017;60:187-97.
DOI: https://doi.org/10.1016/j.pcad.2017.08.006
Lund LH, Claggett B, Liu J, et al. Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum. Eur J Heart Fail 2018;20:1230-39.
DOI: https://doi.org/10.1002/ejhf.1149
Wang TJ, Evans JC, Benjamin EJ, et al. Natural history of asymptomatic left ventricular systolic dysfunction in the community. Circulation 2003;108:977–82.
DOI: https://doi.org/10.1161/01.CIR.0000085166.44904.79
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891-975.
DOI: https://doi.org/10.1002/ejhf.592
Fonarow GC, Stough WG, Abraham WT, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol 2007;50:768–77.
DOI: https://doi.org/10.1016/j.jacc.2007.04.064
Sweitzer NK, Lopatin M, Yancy CW, et al. Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (> or =55%) versus those with mildly reduced (40% to 55%) and moderately to severely reduced (<40%) fractions. Am J Cardiol 2008;101:1151–6.
DOI: https://doi.org/10.1016/j.amjcard.2007.12.014
Abraham WT, Fonarow GC, Albert NM, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: Insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) J Am Coll Cardiol 2008;52:347-56.
Butler J, Fonarow GC, Zile MR, et al. Developing therapies for heart failure with preserved ejection fraction: current state and future directions. J Am Coll Cardiol HF 2014;2:97–112.
Van Veldhuisen DJ, Anker SD, Ponikowski P, Macdougali IC. Anaemia and iron deficiency in heart failure: mechanisms and therapeutic approaches. Nat Rev Cardiol 2011;8:485-93
DOI: https://doi.org/10.1038/nrcardio.2011.77
Okonko DO, Grzeslo A, Witkowski T, et al. Effect of intravenous iron sucrose on exercise tolerance in anemic and non-anemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized controlled observer blinded trial. J Am Coll Cardiol 2008;51:103-12.
DOI: https://doi.org/10.1016/j.jacc.2007.09.036
Bonsu KO, Owusu IK, Buabeng KO, et al. Clinical characteristics and prognosis of patients admitted for heart failure: a 5 year retrospective study of African patients. Int J Cardiol 2017;238:128-35.
DOI: https://doi.org/10.1016/j.ijcard.2017.03.014
Shiga T, Suzuki A, Haruta S, et al. Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan. ESC Heart Fail 2019;6:475-86.
DOI: https://doi.org/10.1002/ehf2.12418
Webb J, Drapper J, Fovargue L, et al. Is heart failure with mid-range ejection fraction (HFmrEF) a distinct clinical entity or an overlap group? IJC Heart Vasculature 2018;21:1–6.
DOI: https://doi.org/10.1016/j.ijcha.2018.06.001
Kapoor JR, Kapoor R, Ju C, Heidenreich PA, et al. Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. J Am Coll Cardiol HF 2016;4:464–72.
DOI: https://doi.org/10.1016/j.jchf.2016.02.017
Coles AH, Tisminetzky M, Yarzebski J, et al. Magnitude of and prognostic factors associated with 1-year mortality after hospital discharge for acute decompensated heart failure based on ejection fraction findings. J Am Heart Assoc 2015;4:e002303.
DOI: https://doi.org/10.1161/JAHA.115.002303
Triposkiadis F, Butler J, Abboud FM, et al. The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur Heart J 2019;40:2155–63.
DOI: https://doi.org/10.1093/eurheartj/ehz158
Farmakis D, Simitsis P, Bistola V, et al. Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome. Clin Res Cardiol 2017;106:359-68
DOI: https://doi.org/10.1007/s00392-016-1063-0
Bhambhani V, Kizer JR, Lima JAC, et al. Predictors and outcomes of heart failure with mid-range ejection fraction. Eur J Heart Fail 2018;20:651-9.
DOI: https://doi.org/10.1002/ejhf.1091
Lyu S, Yu L, Tan H, et al. Clinical characteristics and prognosis of heart failure with mid-range ejection fraction: insights from a multi-centre registry study in China. BMC Cardiovasc Disord 2019;19:209.
DOI: https://doi.org/10.1186/s12872-019-1177-1
Hsich EM, Grau-Sepulveda MV, Hernandez AF, et al. Relationship between sex, ejection fraction, and B-type natriuretic peptide levels in patients hospitalized with heart failure and associations with in-hospital outcomes: findings from the Get With The Guideline-Heart Failure Registry. Am Heart J 2013;166:1063-71.
DOI: https://doi.org/10.1016/j.ahj.2013.08.029
Tromp J, Khan MA, Klip IT, et al. Biomarker profiles in heart failure patients with preserved and reduced ejection fraction. J Am Heart Assoc 2017;6:e003989.
DOI: https://doi.org/10.1161/JAHA.116.003989
Prastaro M, D’Amore C, Paolilo S, et al. Prognostic role of transthoracic echocardiography in patients affected by heart failure and reduced ejection fraction. Heart Fail Rev 2015;20:305-16.
DOI: https://doi.org/10.1007/s10741-014-9461-8
Sani MU, Davison BA, Cotter G, et al. Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa: insights from THESUS-HF. Cardiovasc J Afr 2017;28:60-7.
DOI: https://doi.org/10.5830/CVJA-2016-070
Sliwa K, Davison BA, Mayosi BM, et al. Readmission and death after an acute heart failure event: predictors and outcomes in sub-Saharan Africa: results from the THESUS-HF registry. Eur Heart J 2013;34:3151-9.
DOI: https://doi.org/10.1093/eurheartj/eht393
How to Cite
Akintunde, A. (2021). Clinical characteristics and correlates of patients with heart failure with mid-range ejection fraction in southwest Nigeria. Annals of Clinical and Biomedical Research, 2(2). https://doi.org/10.4081/acbr.2021.150
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