The continuous heart failure spectrum: moving beyond an ejection fraction classification.

Details

Serval ID
serval:BIB_BD207ABF151E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The continuous heart failure spectrum: moving beyond an ejection fraction classification.
Journal
European heart journal
Author(s)
Triposkiadis F., Butler J., Abboud F.M., Armstrong P.W., Adamopoulos S., Atherton J.J., Backs J., Bauersachs J., Burkhoff D., Bonow R.O., Chopra V.K., de Boer R.A., de Windt L., Hamdani N., Hasenfuss G., Heymans S., Hulot J.S., Konstam M., Lee R.T., Linke W.A., Lunde I.G., Lyon A.R., Maack C., Mann D.L., Mebazaa A., Mentz R.J., Nihoyannopoulos P., Papp Z., Parissis J., Pedrazzini T., Rosano G., Rouleau J., Seferovic P.M., Shah A.M., Starling R.C., Tocchetti C.G., Trochu J.N., Thum T., Zannad F., Brutsaert D.L., Segers V.F., De Keulenaer G.W.
ISSN
1522-9645 (Electronic)
ISSN-L
0195-668X
Publication state
Published
Issued date
01/07/2019
Peer-reviewed
Oui
Volume
40
Number
26
Pages
2155-2163
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
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.
Keywords
Ejection fraction, Endothelium, Heart failure, Pathophysiology
Pubmed
Create date
15/04/2019 17:27
Last modification date
20/10/2020 5:23
Usage data