Heart failure with reduced ejection fraction: A review of clinical status and meta-analyses of diagnosis by 3D echocardiography and natriuretic peptides-guided heart failure therapy

Heart failure (HF) with reduced ejection fraction (HFrEF) is a clinical syndrome in which pathological myocardial stress or injury leads to cardiac inability to perfuse the body's vital organs at rest or during exertion, usually documented by left ventricular ejection fraction 40% on echocardiography. HFrEF constitutes about a half of all HF hospitalizations and remains the most common discharge diagnosis in older adults. Despite major advancements in the treatment of HFrEF and concomitant improvement in both outcomes and survival, nonspecific symptoms continue to make diagnosis difficult as well as HFrEF has the most ominous prognosis relative to HF with mid-range and preserved ejection fraction. Even upon diagnosis, predicting which patients are at a greater risk of death or major cardiovascular events remains a clinical challenge. In a critical appraisal of published evidence on HFrEF, this review purposes to provide a comprehensive understanding of the clinical status and management of HFrEF.