Key result
Bimodal LVEF distribution in acute HF reveals sex-specific cutoffs of ~45% in men and ~52% in women.
Why the study?
The scientific justification and clinical relevance of categorizing heart failure patients by LVEF and the identification of appropriate LVEF cut-off values remain uncertain, with debate over discrete subgroups versus a continuous LVEF spectrum.
Observational (n=470)
No
Answers are grounded in this paper and cite their sources.
May support sex-specific LVEF thresholds in acute HF classification; hypothesis-generating and requires prospective validation before practice change.
AIMS: There is an ongoing discussion whether the categorization of patients with heart failure according to left ventricular ejection fraction (LVEF) is scientifically justified and clinically relevant. Major efforts are directed towards the identification of appropriate cut-off values to correctly allocate heart failure-specific pharmacotherapy. Alternatively, an LVEF continuum without definite subgroups is discussed. This study aimed to evaluate the natural distribution of LVEF in patients presenting with acutely decompensated heart failure and to identify potential subgroups of LVEF in male and female patients. METHODS AND RESULTS: We identified 470 patients (mean age 75 ± 11 years, n = 137 female) hospitalized for acute heart failure in whom LVEF could be quantified by Simpson's method in an in-hospital echocardiogram. Non-parametric modelling revealed a bimodal shape of the LVEF distribution. Parametric modelling identified two clusters suggesting two LVEF peaks with mean (variance) of 61% (9%) and 31% (10%), respectively. Sub-differentiation by sex revealed a sex-specific bimodal clustering of LVEF. The respective threshold differentiating between 'high' and 'low' LVEF was 45% in men and 52% in women. CONCLUSIONS: In patients presenting with acute heart failure, LVEF clustered in two subgroups and exhibited profound sex-specific distributional differences. These findings might enrich the scientific process to identify distinct subgroups of heart failure patients, which might each benefit from respectively tailored (pharmaco)therapies.
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Morbach et al. (2021) conducted an observational in Acute heart failure (n=470). Sex (Male vs Female) was evaluated on Natural distribution of LVEF and identification of subgroups. In patients with acute heart failure, LVEF exhibited a bimodal distribution with distinct sex-specific thresholds for differentiating high and low LVEF.
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