Mid-Range Heart Failure: A New Kid on the Block?

Heart failure may be defined as a clinical syndrome with a great range of left ventricle abnormalities, in its function and/or its structure. In 2016, with reference to the ejection fraction, the European Society of Cardiology guidelines, for the first time, introduced a separate clinical entity, called heart failure with mid-range ejection fraction (HFmrEF). The introduction of the mid-range heart failure into the clinical practice and its involvement into the current ESC guidelines led to the inclusion of these patients into great clinical trials as a separate cohort of patients. The biomarker panel, the exact pathophysiological mechanism and the most effective therapy approach are yet to be determined and most probably depend on the underlying etiology of the heart failure. Identification of the proper pathophysiological mechanism of midrange heart failure will probably answer the current question about whether this type of heart failure is a transitional form between reduced and preserved ejection fraction or represents a distinct and a brand new clinical entity.