From the Guidelines
A patient with HFrEF will often have systolic dysfunction as the associated condition. This is because HFrEF is defined by a reduced ejection fraction (less than 40%), which is a direct result of systolic dysfunction, where the heart's ability to contract and eject blood is impaired 1. The pathophysiology of HFrEF involves weakened ventricular contraction, leading to decreased cardiac output and the clinical syndrome of heart failure. According to the 2013 ACCF/AHA guideline for the management of heart failure, HFrEF is also referred to as systolic HF, and it is the type of heart failure where efficacious therapies have been demonstrated to date 1.
Some key characteristics of HFrEF include:
- Reduced ejection fraction (less than 40%)
- Impaired cardiac contractility
- Decreased cardiac output
- Symptoms such as shortness of breath, fatigue, and fluid retention
- Treatment typically focuses on medications that improve cardiac contractility and reduce the workload on the heart, including ACE inhibitors or ARBs, beta-blockers, aldosterone antagonists, and in some cases, SGLT2 inhibitors.
In contrast, diastolic dysfunction is seen in HFpEF, which is a distinct entity from HFrEF, with different underlying mechanisms and treatment approaches 1. Restrictive cardiomyopathy and hypertrophic cardiomyopathy are also separate conditions with unique pathophysiologies and management strategies. Therefore, systolic dysfunction is the most closely associated condition with HFrEF, and understanding its underlying mechanisms is crucial for effective management and treatment.
From the FDA Drug Label
In two placebo controlled, 12-week clinical studies using doses of lisinopril up to 20 mg, lisinopril as adjunctive therapy to digitalis and diuretics improved the following signs and symptoms due to congestive heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention
- The patient with HFrEF (Heart Failure with Reduced Ejection Fraction) will often have Systolic dysfunction as an associated condition.
- Systolic dysfunction is directly related to HFrEF, as it is characterized by the heart's inability to contract and pump blood effectively, resulting in reduced ejection fraction 2.
From the Research
Associated Conditions with HFrEF
The following are associated conditions with Heart Failure with Reduced Ejection Fraction (HFrEF):
- Systolic dysfunction: This is a condition where the heart is unable to contract properly, leading to a reduction in the ejection fraction 3, 4.
- Diastolic dysfunction is not directly mentioned in the provided studies as an associated condition with HFrEF, however, HFrEF is characterized by systolic dysfunction.
- Restrictive cardiomyopathy and hypertrophic cardiomyopathy are types of cardiomyopathies, but they are not directly mentioned in the studies as associated conditions with HFrEF.
Key Characteristics of HFrEF
Some key characteristics of HFrEF include:
- Left ventricular ejection fraction (LVEF) of 40% or less 4
- Progressive left ventricular dilatation and adverse cardiac remodeling 4
- Symptoms such as dyspnea or exertional limitation due to impairment of ventricular filling or ejection of blood or both 4
Treatment of HFrEF
The treatment of HFrEF involves a combination of medications and device therapies, including:
- Diuretics to relieve symptoms 3, 4
- Beta blockers to improve ejection fraction and reduce mortality 3, 5
- Angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers to reduce mortality and hospitalizations 4
- Mineralocorticoid receptor antagonists to reduce mortality and hospitalizations 4
- Sodium-glucose cotransporter 2 inhibitors to reduce hospitalizations and mortality 6, 5
- Device therapies such as cardiac resynchronization therapy, transcatheter mitral valve repair, and implantable cardiac defibrillators 4