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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:338-46 - Vol. 70 Num.05 DOI: 10.1016/j.rec.2016.11.016

Mid-range Ejection Fraction Does Not Permit Risk Stratification Among Patients Hospitalized for Heart Failure

Inés Gómez-Otero a,, Andreu Ferrero-Gregori b, Alfonso Varela Román a, José Seijas Amigo a, Domingo A. Pascual-Figal c, Juan Delgado Jiménez d, Jesús Álvarez-García b, Francisco Fernández-Avilés e, Fernando Worner Diz f, Luis Alonso-Pulpón g, Juan Cinca b, José Ramón Gónzalez-Juanatey a

a Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
b Departamento de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
c Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
d Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
e Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
f Departamento de Cardiología, Hospital Arnau de Vilanova, Lleida, Spain
g Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain

Refers to

Left Ventricular Ejection Fraction in Patients With Acute Heart Failure: A Limited Tool?
Andreas P. Kalogeropoulos, Javed Butler
Rev Esp Cardiol. 2017;70:318-9
Full text - PDF


Heart failure. Mid-range ejection fraction. Clinical characteristics. Prognosis.


Introduction and objectives

European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry).


A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%. Baseline patient characteristics were examined, and outcome measures were mortality and readmission for heart failure at 1-, 6-, and 12-month follow-up. Propensity score matching was used to compare the HFmrEF group with the other ejection fraction groups.


Among the study participants, 583 (41%) had HFrEF, 227 (16%) HFmrEF, and 610 (43%) HFpEF. HFmrEF patients had a clinical profile similar to that of HFpEF patients in terms of age, blood pressure, and atrial fibrillation prevalence, but shared with HFrEF patients a higher proportion of male participants and ischemic etiology, and use of class I drugs targeting HFrEF. All other features were intermediate, and comorbidities were similar among the 3 groups. There were no significant differences in all-cause mortality, cause of death, or heart failure readmission. The similar outcomes were confirmed in the propensity score matched cohorts.


The HFmrEF patient group has characteristics between the HFrEF and HFpEF groups, with more similarities to the HFpEF group. No between-group differences were observed in total mortality, cause of death, or heart failure readmission.


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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved