key: cord-0835814-wh6td8v0
authors: Martínez-Sellés, Manuel; Xu, Dachun; Zhang, Jian; Ong, Sang-Bing
title: Editorial: HFpEF and HFmrEF: Different Sides of the Same Coin?
date: 2022-05-05
journal: Front Cardiovasc Med
DOI: 10.3389/fcvm.2022.916534
sha: 0c31794192441efbf593d266448088d36fd66277
doc_id: 835814
cord_uid: wh6td8v0

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Heart failure (HF) has traditionally been divided into distinct phenotypes based on left ventricular ejection fraction (LVEF). The most common way to evaluate LVEF is echocardiography, yet its measurements are subject to substantial variability associated with the technique itself as well as hemodynamic conditions of the patient. In any case, as clinical trials have used specific cut-offs for LVEF, some treatment benefits have only been proven below a certain LVEF value. This is the main reason that explains the recommendation of the European Society of Cardiology in the use of the following three categories (1): HF with reduced ejection fraction (HFrEF, LVEF ≤40%), HF with mildly reduced ejection fraction (HFmrEF, LVEF 41-49%), and HF with preserved ejection fraction (HFpEF, LVEF>50%). In any case, most studies that have included patients with HFmrEF suggest that they may benefit from similar therapies to those with HFrEF. This was the main reason for the recent change of the name in the group of patients with LVEF 41-49% that was previously named "heart failure with mid-range ejection fraction."

This Research Topic aims to focus on patients with HFpEF and HFmrEF, highlighting their similarities and differences. The clinical profile of these patients has particularities that differentiate them from HFrEF, including a more advanced age and a higher prevalence in women (2, 3). In addition, biomarkers and ionic parameters have also a different impact according to LVEF and their role, levels and thresholds in HFpEF and HFmrEF are different from the ones observed in HFrEF (4). focusing on liver function. The authors found that elevated serum cholestasis markers such as total bilirubin and alkaline phosphatase were associated with a poor clinical outcome. Wang et al. show that the MELD-XI score is associated with short-term adverse events in these patients and provides additional discriminatory capacity to risk stratification models in hospitalized patients. Huang et al. describe the association of weight change with mortality risk in patients from the Americas from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist study, showing that weight loss is related with all-cause mortality, while weight gain is not associated with better survival.

Animal studies are also presented whereby, Zhang et al. describe the alteration of N6-methyladenosine RNA methylation in patients and in a mouse model of HFpEF, suggesting that the modulation of epitranscriptomic processes might be an interesting target for therapeutic interventions. In summary, this Research Topic highlights the importance of distinguishing between HFpEF and HFmrEF. The prevalence of HF with LVEF <40% is similar or even higher than the prevalence of HFrEF, but the amount of data regarding these conditions is quite scarce when compared against the number of clinical trials that have shown important benefits of HFrEF treatments. Further studies specifically focused on these patients may help to clarify their pathophysiology and to provide new therapeutic tools.

MM-S designed the manuscript and wrote the first draft. All authors contributed and approved the final draft.

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)

Editorial: the role of sex in heart failure and transplantation

Sex influence on heart failure prognosis

Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction

The authors would like to thank the contribution of the other Topic Editors of this Research Topic HFpEF and HFmrEF: Different Sides of the Same Coin? Drs. Jingmin Zhou, Gianluigi Savarese, and Chen Liu.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Publisher's Note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.Copyright © 2022 Martínez-Sellés, Xu, Zhang and Ong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.