Background: Heart failure (HF) with mid-range ejection fraction (EF) (HFmrEF) has attracted increasing attention in\nrecent years. However, the understanding of HFmrEF remains limited, especially among Asian patients. Therefore,\nanalysis of a Chinese HF registry was undertaken to explore the clinical characteristics and prognosis of HFmrEF.\nMethods: A total of 755 HF patients from a multi-centre registry were classified into three groups based on EF\nmeasured by echocardiogram at recruitment: HF with reduced EF (HFrEF) (n = 211), HFmrEF (n = 201), and HF with\npreserved EF (HFpEF) (n = 343). Clinical data were carefully collected and analyzed at baseline. The primary endpoint\nwas all-cause mortality and cardiovascular mortality while the secondary endpoints included hospitalization due to\nHF and major adverse cardiac events (MACE) during 1-year follow-up. Cox regression and Logistic regression were\nperformed to identify the association between the three EF strata and 1-year outcomes.\nResults: The prevalence of HFmrEF was 26.6% in the observed HF patients. Most of the clinical characteristics of\nHFmrEF were intermediate between HFrEF and HFpEF. But a significantly higher ratio of prior myocardial\ninfarction (p = 0.002), ischemic heart disease etiology (p = 0.004), antiplatelet drug use (p = 0.009), angioplasty\nor stent implantation (p = 0.003) were observed in patients with HFmrEF patients than those with HFpEF and\nHFrEF. Multivariate analysis showed that the HFmrEF group presented a better prognosis than HFrEF in all-cause\nmortality [p = 0.022, HR (95%CI): 0.473(0.215-0.887)], cardiovascular mortality [p = 0.005, HR (95%CI): 0.270(0.108-0.672)]\nand MACE [p = 0.034, OR (95%CI): 0.450(0.215-0.941)] at 1 year. However, no significant differences in 1-year outcomes\nwere observed between HFmrEF and HFpEF.\nConclusion: HFmrEF is a distinctive subgroup of HF. The strikingly prevalence of ischemic history among patients with\nHFmrEF might indicate a key to profound understanding of HFmrEF. Patients in HFmrEF group presented better 1-year\noutcomes than HFrEF group. The long-term prognosis and optimal medications for HFmrEF require further\ninvestigations.
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