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Heart failure with mildly reduced ejection fraction: from diagnosis to treatment. Gaps and dilemmas in current clinical practice

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Abstract

Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) was recently recognised as a distinct clinical entity. Although guideline diagnostic criteria for HFmrEF are well defined, there is substantial variation in clinical characteristics, pathophysiology and prognosis of this group of patients. The heterogeneity in clinical presentations of HFmrEF arises from diverse patients’ risk factors, coexisting comorbidities, which modify clinical signs and symptoms, and stage of the disease. On the other hand, HFmrEF shares common clinical features with other HF subgroups. However, the knowledge about the mechanisms and therapeutic approaches in HFmrEF is far from being completely understood. Therefore, HFmrEF represents one of the most intriguing areas of heart failure research. The aim of this review is therefore to highlight the diagnostic challenges in HFmrEF and to provide a constructive appraisal on the pathophysiology of HFmrEF, as well as to discuss the role of pharmacological and nonpharmacological treatment options in patients with HFmrEF.

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Authors and Affiliations

  1. Department of Cardiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia

    Marta Cvijic

  2. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Marta Cvijic

  3. Department of Cardiology, 1St State Hospital, Nur-Sultan, Kazakhstan

    Yelena Rib

  4. Department of Internal Diseases, Faculty of Medicine, Astana Medical University, Nur-Sultan, Kazakhstan

    Yelena Rib

  5. Department of Cardiology, General Hospital Celje, Celje, Slovenia

    Suzana Danojevic

  6. ARES Centers of Excellence in Interventional Cardiology, Monza Hospital, Bucharest, Romania

    Crina Ioana Radulescu

  7. University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

    Crina Ioana Radulescu

  8. Tbilisi Heart Center, Tbilisi, Georgia

    Natia Nazghaidze

  9. Heart Sector, Hygeia Hospitals Groups, Athens, Greece

    Panos Vardas

  10. Cardiology Department, Medical School, University of Crete, Heraclion, Greece

    Panos Vardas

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  1. Marta Cvijic
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The listed authors contributed to the manuscript as follows: conception and design of manuscript, or both (M.C, and P.V.); manuscript drafting or critical revision for important intellectual content (M.C., Y.R., S.D., C.I.R., N.N., P.V.); final approval of the manuscript submitted (M.C., Y.R., S.D., C.I.R., N.N., P.V.).

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Dr. Cvijic, Dr. Rib, Dr. Danojevic, Dr. Radulescu, Dr. Nazghaidze, and Dr.Vardas report no relationships that could be construed as a conflict of interest. Dr. Vardas reports personal fees from European Society of Cardiology, personal fees from Hygeia Hospitals Group, HHG, and personal fees from Servier International, outside the submitted work.

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Cvijic, M., Rib, Y., Danojevic, S. et al. Heart failure with mildly reduced ejection fraction: from diagnosis to treatment. Gaps and dilemmas in current clinical practice. Heart Fail Rev 28, 767–780 (2023). https://doi.org/10.1007/s10741-022-10267-1

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