title: 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).
abstract: While the conditions of heart failure (HF) with reduced (HFrEF, LVEF < 40%) and preserved (HFpEF, LVEF ≥ 50%) left ventricular ejection fraction (LVEF) are well characterized, it is unknown whether patients with HF and mid-range LVEF (HFmrEF, LVEF 40-49%) have to be regarded as a separate clinical entity. The aim of this study was to characterize these three populations and to compare outcome and response to therapy.
  
  
  
  The analysis was based on the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) comprising a population with established HF including the whole spectrum of LVEF. Of the 622 patients, 108 (17%) were classified as having HFmrEF. This group was in general found to be 'intermediate' regarding clinical characteristics with a comparable and high burden of comorbidities and equally impaired quality of life but was more likely to have coronary artery disease as compared with the HFpEF group. During a median follow-up of 794 days, mortality was 39.7% without significant differences between groups. N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided as compared with standard therapy resulted in improved survival free of HF hospitalizations in HFrEF and HFmrEF, but not in HFpEF.
  
  
  
  Although the 'intermediate' clinical profile of HFmrEF between HFrEF and HFpEF would support the conclusion that HFmrEF is a distinct clinical entity, we hypothesize that HFmrEF has to be categorized as HFrEF because of the high prevalence of coronary artery disease and the similar benefit of NT-proBNP-guided therapy in HFrEF and HFmrEF, in contrast to HFpEF.
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.|Division of Cardiology, Internal Medicine University Department, Kantonsspital Baselland, Bruderholz, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Rickenbacher
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Beat A
authors.initials: BA
authors.lastname: Kaufmann
authors.affiliation: Cardiology Division, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: Micha T
authors.initials: MT
authors.lastname: Maeder
authors.affiliation: Cardiology Division, Triemli Hospital, Zürich, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernheim
authors.affiliation: Cardiology Division, University Hospital, Leuven, Belgium.
authors.forename: Kaatje
authors.initials: K
authors.lastname: Goetschalckx
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Otmar
authors.initials: O
authors.lastname: Pfister
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfisterer
authors.affiliation: Division of Cardiology, University Hospital Basel, Switzerland.|Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D019468:Disease Management; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D002317:Cardiovascular Agents
keywords: Heart failure; Heart failure with mid-range ejection fraction; Heart failure with preserved ejection fraction; Heart failure with reduced ejection fraction; Prognosis