From the Guidelines
A moderately reduced ejection fraction is defined as a left ventricular ejection fraction (LVEF) that falls between 26% and 40%. This definition is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.
Definition and Classification
The classification of heart failure based on ejection fraction is crucial for guiding treatment strategies and monitoring.
- Heart failure with preserved ejection fraction (HFpEF) is defined as LVEF ≥50%
- Heart failure with mildly reduced ejection fraction (HFmrEF) is defined as LVEF between 41% and 49%
- Heart failure with reduced ejection fraction (HFrEF) is defined as LVEF ≤40%
Moderately Reduced Ejection Fraction
A moderately reduced ejection fraction falls within the HFrEF category, with an LVEF between 26% and 40%.
- This condition is characterized by impaired systolic function, which can lead to symptoms such as shortness of breath, fatigue, and fluid retention
- Treatment for HFrEF typically includes medications such as ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists
Importance of Accurate Diagnosis
Accurate diagnosis and classification of heart failure are essential for providing appropriate treatment and improving patient outcomes.
- The use of quantitative measurement of ejection fraction is preferred over qualitative measurement
- The hierarchy for determining ejection fraction should be followed, with radionuclide ventriculography, magnetic resonance imaging (MRI), and echocardiography being the preferred modalities
Recent Guidelines and Recommendations
Recent guidelines and recommendations emphasize the importance of accurate diagnosis and treatment of heart failure, including the use of evidence-based medications and devices 1.
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends the use of SGLT2 inhibitors in patients with HFmrEF to decrease HF hospitalizations and cardiovascular mortality
- The 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction highlights the challenges in diagnosing HFpEF and the importance of using the correct terminology
In summary, a moderately reduced ejection fraction is defined as an LVEF between 26% and 40%, and accurate diagnosis and classification of heart failure are crucial for providing appropriate treatment and improving patient outcomes.
From the Research
Definition of Moderately Reduced Ejection Fraction
- The definition of moderately reduced ejection fraction is not explicitly stated in the provided studies, but we can infer that it refers to a left ventricular ejection fraction (LVEF) between 40% and 49% 2, 3, 4.
- This range is also referred to as heart failure with mid-range ejection fraction (HFmrEF) or heart failure with mildly reduced ejection fraction (HFmrEF) 2, 3, 4.
- Heart failure with reduced ejection fraction (HFrEF) is generally defined as an LVEF below 40%, while heart failure with preserved ejection fraction (HFpEF) is defined as an LVEF above 50% 2, 3, 4.
- One study defines HFrEF as an LVEF <50% 5, but this is not consistent with the other studies.
Characteristics of Moderately Reduced Ejection Fraction
- Patients with moderately reduced ejection fraction (HFmrEF) have heterogeneous clinical characteristics that resemble both HFrEF and HFpEF 3, 4.
- The prevalence of HFmrEF is estimated to be around 10-25% of the overall population of patients with heart failure 4.
- HFmrEF is considered an intermediate clinical entity between HFrEF and HFpEF, with a higher prevalence of ischemic heart disease similar to HFrEF 4.
- The risk of cardiovascular events is lower in patients with HFmrEF compared to HFrEF, but the risk of non-cardiovascular adverse events is similar or greater 4.