Heart failure with reduced, mildly reduced, or preserved left ventricular ejection fraction: Has reasoning been lost?

Figure 1 There is significant discordance in the normal values of left ventricular ejection fraction reported by several major scientific societies and associations. This makes the classification of heart failure based on the left ventricular ejection fraction problematic. ACCF: American College of Cardiology Foundation; AHA: American Heart Association; ASE: American Society of Echocardiography; EACVI: European Association of Cardiovascular Imaging; ESC: European Society of Cardiology.

Figure 2 Left ventricular ejection fraction adjusted hazard ratios in patients with heart failure (number of echocardiograms = 40616). Left ventricular ejection fraction (LVEF) intervals are inclusive of the lower threshold. Error bars represent the 95%CI. The referent group was outpatients with an LVEF of 60%-65%. While 51192 echocardiograms were performed on patients with heart failure in the primary analysis, only 40616 echocardiograms are represented in this figure due to excluding echocardiograms missing measurements of end-diastolic volume index or wall thicknesses, for which adjustments were made in the analysis. Citation: Wehner GJ, Jing L, Haggerty CM, Suever JD, Leader JB, Hartzel DN, Kirchner HL, Manus JNA, James N, Ayar Z, Gladding P, Good CW, Cleland JGF, Fornwalt BK. Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie? Eur Heart J 2020; 41(12): 1249-1257. Copyright ©The Author(s) 2019. Published by the European Society of Cardiology.

Figure 3 Incident rate of cardiovascular-related mortality. The rate of cardiovascular (CV)-related mortality per 1000 person-years is presented separately for women (top graph) and men (bottom) according to 5-unit increments in the left ventricular ejection fraction. The total number of deaths contributing to the rate of mortality in each group (red numerals) is provided above the horizontal axis. IQR: Interquartile range. Citation: Stewart S, Playford D, Scalia GM, Currie P, Celermajer DS, Prior D, Codde J, Strange G; NEDA Investigators. Ejection fraction and mortality: a nationwide register-based cohort study of 499 153 women and men. Eur J Heart Fail 2021; 23(3): 406-416. Copyright ©The Author(s) 2020. Published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.