Published online before print June 8, 2009, doi: 10.1161/CIRCULATIONAHA.109.870006
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(Circulation. 2009;119:3044-3046.)
© 2009 American Heart Association, Inc.
Editorial |
The Heart Failure Spectrum
Time for a Phenotype-Oriented Approach
From the Centre for Heart Failure and Cardiac Rehabilitation, Middelheim Hospital, University of Antwerp, Antwerp, Belgium.
Correspondence to Gilles De Keulenaer, MD, PhD, Universiteitsplein 1, Campus Drie Eiken, Bldg T, 2nd Floor, 2610 Wilrijk, Belgium. Email gilles.dekeulenaer@ua.ac.be
Key Words: Editorials • heart failure • ventricular ejection fraction • models, cardiovascular • risk factors
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Chronic heart failure (HF) occurs at any level of left ventricular ejection fraction (LVEF). Mostly driven by clinical trial design, HF has nevertheless been dichotomized according to LVEF as HF with preserved ejection fraction (HFPEF) or HF with reduced ejection fraction (HFREF). During the ongoing discussion on the pathophysiology of HF, some researchers have focused on differences whereas others have focused on the overlap between HFPEF and HFREF. These discussions have received great attention especially because recent clinical trials have shown an unexplained resistance to therapy (especially to renin-angiotensin-aldosterone system inhibition) in HFPEF. With no alternative therapies available, medical progress in HFPEF is stagnating.
Article see p 3070
The current issue of Circulation contains a report on clinical characteristics and risk factors in patients with incident HF among Framingham Heart Study participants.1 Incident HF was classified as either HFREF when LVEF was 
45% or as HFPEF when LVEF was >45%. HFPEF accounted for 41% of the inclusions. Female gender, elevated systolic blood pressure, and atrial fibrillation enhanced the odds to be classified as HFPEF whereas prior myocardial infarction and left bundle branch block reduced these odds. Among preonset HF patient characteristics, only female gender increased the odds of developing HFPEF instead of HFREF. These data are largely consistent with previous surveys on patient characteristics in HF and add information to this syndrome’s phenotypic diversity.
As stated in the article, the investigators’ rationale to subdivide patient records into 2 groups, according to an a priori cutoff value of LVEF of 45%,
Related Article:
Circulation 2009 119: 3070-3077.