Abstract
According to the European Society of Cardiology guidelines, HF is defined as a clinical syndrome characterized by typical symptoms (e.g., breathlessness, ankle swelling, and fatigue) that may be accompanied by signs (e.g., elevated jugular venous pressure, pulmonary crackles, and peripheral edema) caused by a structural and/or functional cardiac abnormality resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress [1]. Heart failure can present with preserved ejection fraction (HFpEF), midrange ejection fraction (HFmrEF), or reduced ejection fraction (HFrEF).
These three entities differ in their epidemiological profiles, presentation, and mechanisms. Compared with HFrEF, patients with HFpEF are older and more commonly have hypertension and atrial fibrillation, while a history of myocardial infarction is less common.
In several studies, HFpEF was more common in females than in males. This may be partially explained by sex distribution in the highest age groups (60% of the US population aged >=75 years are women).
A recent analysis has shown that among individuals of similar age and similar prevalence of other HF risk factors, women are not at higher risk of HFpEFthan men but are at a lower risk for HFrEF [2]. Heart failure with midrange ejection fraction is an intermediate phenotype, with the prevalence of ischemic heart disease (IHD) similar to that of HFrEF, while other demographic characteristics, symptom profile, comorbidities, laboratory values, and short-term outcomes are closer to those with HFpEF [3].