The continuous heart failure spectrum: moving beyond an ejection fraction classification. (8th April 2019)

• Record Type: Journal Article
• Authors: Triposkiadis, Filippos; Butler, Javed; Abboud, Francois M; Armstrong, Paul W; Adamopoulos, Stamatis; Atherton, John J; Backs, Johannes; Bauersachs, Johann; Burkhoff, Daniel; Bonow, Robert O; Chopra, Vijay K; de Boer, Rudolf A; de Windt, Leon; Hamdani, Nazha; Hasenfuss, Gerd; Heymans, Stephane; Hulot, Jean-Sébastien; Konstam, Marvin; Lee, Richard T; Linke, Wolfgang A; Lunde, Ida G; Lyon, Alexander R; Maack, Christoph; Mann, Douglas L; Mebazaa, Alexandre; Mentz, Robert J; Nihoyannopoulos, Petros; Papp, Zoltan; Parissis, John; Pedrazzini, Thierry; Rosano, Giuseppe; Rouleau, Jean; Seferovic, Petar M; Shah, Ajay M; Starling, Randall C; Tocchetti, Carlo G; Trochu, Jean-Noel; Thum, Thomas; Zannad, Faiez; Brutsaert, Dirk L; Segers, Vincent F; De Keulenaer, Gilles W;
• Is Part Of: European heart journal. Volume 40:Number 26(2019)
• Page Start: 2155
• Page End: 2163
• Publication Date: 2019-04-08
• Subjects: Heart failure -- Ejection fraction -- Pathophysiology -- Endothelium; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehz158
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Randomized clinical trials initially used heart failure (HF) patients with low left ventricular ejection fraction (LVEF) to select study populations with high risk to enhance statistical power. However, this use of LVEF in clinical trials has led to oversimplification of the scientific view of a complex syndrome. Descriptive terms such as 'HFrEF' (HF with reduced LVEF), 'HFpEF' (HF with preserved LVEF), and more recently 'HFmrEF' (HF with mid-range LVEF), assigned on arbitrary LVEF cut-off points, have gradually arisen as separate diseases, implying distinct pathophysiologies. In this article, based on pathophysiological reasoning, we challenge the paradigm of classifying HF according to LVEF. Instead, we propose that HF is a heterogeneous syndrome in which disease progression is associated with a dynamic evolution of functional and structural changes leading to unique disease trajectories creating a spectrum of phenotypes with overlapping and distinct characteristics. Moreover, we argue that by recognizing the spectral nature of the disease a novel stratification will arise from new technologies and scientific insights that will shape the design of future trials based on deeper understanding beyond the LVEF construct alone.