Regarding the HF hospitalization, the meta-analysis also did not show any significant differences between HFrEF and HFmrEF or between HFpEF and HFmrEF (RR 0

Regarding the HF hospitalization, the meta-analysis also did not show any significant differences between HFrEF and HFmrEF or between HFpEF and HFmrEF (RR 0.92, 95% CI, 0.84-1.01, p = 0.08, and RR 1.05, 95% CI, 0.83-1.33; p = 0.69, respectively.) However, in the CHARM study, all-cause hospitalization was significantly lower in patients with HFmrEF than in the HFpEF phenotype (HR 8.89; 95% CI, 0.81-0.98; p = 0.02).27 When comparing the different HFmrEF in the Rastogi et al.,30 cohort subgroups, the recovered HFmrEF had a better prognosis compared to HFmrEF (p = 0.029) when observing the time until the first hospitalization for any cardiac event. it is fundamental that cardiologists and internists understand the variations and similarities of this fresh phenotype. strong class=”kwd-title” Keywords: Heart Failure/physiopathology, Stroke Volume, Natriuretics Peptides, Diagnostic Imaging, Electrocardiography, Ecocardiography, Magnetic Resonance Imaging Intro The classification and characterization of heart failure Des (HF) by phenotypes has an important relevance in medical practice, since these phenotypes are currently based on remaining ventricular ejection portion (LVEF) and have different characteristics in relation to prognosis and treatment.1 Classically, two main HF phenotypes have been described; the HF with reduced ejection portion (HFrEF) with LVEF 40% and the HF with maintained ejection portion (HFpEF), with LVEF 50%.2-4 Different recommendations have proposed a new phenotype in the current decade, the HF with mid-range ejection portion (HFmrEF). The American College of Sardomozide HCl Cardiology/American Heart Association published a new HF guideline in 2013, in which individuals with LVEF between 41% and 50% were classified as borderline HFpEF.2 In 2016, the ESC recognized HF with LVEF between 40% and 49% as a distinct phenotype; the HFmrEF, primarily intended to activate studies that address epidemiology, etiology, characteristics, and prognostics of this fresh category.3 Finally, the Brazilian Society of Cardiology (BSC) introduced HFmrEF as a new clinical phenotype in its 2018 guideline of acute and chronic HF.5 With the introduction of this new classification, HFmrEF offers received great attention and, consequently, has been better analyzed and characterized. The present review study aims to describe what is currently known about HFmrEF and discuss future perspectives that may contribute to a better approach for this group of individuals. Epidemiology Prevalence In the United States, it is estimated that more than 6.5 million people have HF,6 and the percentage of individuals with HFmrEF is definitely between 13% and 24%.7,8 The prevalence of HFmrEF in studies performed with hospitalized individuals ranged from 13% to 26%,7,9-12 while the prevalence of HFmrEF in outpatients varied from 9% to 21%.8,13-17 The last census of Brazilian Institute for Geography and Statistics (IBGE) in 2010 2010 census showed an increase in the elderly population in Brazil, and therefore a great potential for the increase of at-risk HF individuals. In the DIGITALIS study performed in the city of Niteri, state of Rio de Janeiro, Brazil, a prevalence of 9.3% of HF was recognized in individuals from your family physician system (59 individuals among 633 volunteers),18 in which 64.2% of these individuals were characterized as having HFpEF and 35% as HFrEF.18 Recently, relating to unpublished data based on the DIGITALIS study database, the prevalence Sardomozide HCl of HFmrEF individuals in Niteri was 22%, HFrEF was 19% and HFpEF was 59%. Analysis According to the latest acute HF guideline of BSC,5 the analysis of HF is based on the combination on medical history findings, Sardomozide HCl physical exam, electrocardiogram and chest x-ray results, as detailed in number 1. An echocardiogram should be performed for diagnostic confirmation if there is medical suspicion of HF. In low suspicion instances or if you will find diagnostic doubts, the measurement of mind natriuretic Sardomozide HCl peptides (BNP and/or NT-proBNP) and an echocardiogram should be performed, if available. A normal echocardiogram and/or plasma BNP levels 35 pg/mL and/or NT-proBNP 125 pg/mL make the HF analysis improbable. In the presence of BNP levels 35 pg/mL and/or NT-proBNP 125 pg/mL and/or modified echocardiogram results, the HF analysis becomes probable. The LVEF echocardiography evaluation contributes to creating the HF medical phenotype, since the medical signs and individuals symptoms with HFrEF, HFmrEF and HFpEF are related.3 Open in a separate window Number 1 Diagnostic algorithm in the clinical suspicion of heart failure. Adapted from: Brazilian Guideline for Chronic and Acute Heart Failure of 2018;5 HFrEF: heart failure with reduced ejection.