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

Publication ,  Journal Article
Triposkiadis, F; Butler, J; Abboud, FM; Armstrong, PW; Adamopoulos, S; Atherton, JJ; Backs, J; Bauersachs, J; Burkhoff, D; Bonow, RO; Lee, RT ...
Published in: Eur Heart J
July 1, 2019

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.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 1, 2019

Volume

40

Issue

26

Start / End Page

2155 / 2163

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Reference Values
  • Myocytes, Cardiac
  • Humans
  • Heart Failure
  • Endothelium, Vascular
  • Disease Progression
  • Comorbidity
 

Citation

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Triposkiadis, F., Butler, J., Abboud, F. M., Armstrong, P. W., Adamopoulos, S., Atherton, J. J., … De Keulenaer, G. W. (2019). The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur Heart J, 40(26), 2155–2163. https://doi.org/10.1093/eurheartj/ehz158
Triposkiadis, Filippos, Javed Butler, Francois M. Abboud, Paul W. Armstrong, Stamatis Adamopoulos, John J. Atherton, Johannes Backs, et al. “The continuous heart failure spectrum: moving beyond an ejection fraction classification.Eur Heart J 40, no. 26 (July 1, 2019): 2155–63. https://doi.org/10.1093/eurheartj/ehz158.
Triposkiadis F, Butler J, Abboud FM, Armstrong PW, Adamopoulos S, Atherton JJ, et al. The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur Heart J. 2019 Jul 1;40(26):2155–63.
Triposkiadis, Filippos, et al. “The continuous heart failure spectrum: moving beyond an ejection fraction classification.Eur Heart J, vol. 40, no. 26, July 2019, pp. 2155–63. Pubmed, doi:10.1093/eurheartj/ehz158.
Triposkiadis F, Butler J, Abboud FM, Armstrong PW, Adamopoulos S, Atherton JJ, Backs J, Bauersachs J, Burkhoff D, Bonow RO, Chopra VK, de Boer RA, de Windt L, Hamdani N, Hasenfuss G, Heymans S, Hulot J-S, Konstam M, Lee RT, Linke WA, Lunde IG, Lyon AR, Maack C, Mann DL, Mebazaa A, Mentz RJ, Nihoyannopoulos P, Papp Z, Parissis J, Pedrazzini T, Rosano G, Rouleau J, Seferovic PM, Shah AM, Starling RC, Tocchetti CG, Trochu J-N, Thum T, Zannad F, Brutsaert DL, Segers VF, De Keulenaer GW. The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur Heart J. 2019 Jul 1;40(26):2155–2163.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 1, 2019

Volume

40

Issue

26

Start / End Page

2155 / 2163

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Reference Values
  • Myocytes, Cardiac
  • Humans
  • Heart Failure
  • Endothelium, Vascular
  • Disease Progression
  • Comorbidity