Ejection Fraction Dynamics in Heart Failure Management
Summary
Ejection fraction (EF) quantifies the proportion of blood ejected from the left ventricle with each heartbeat and serves as the cornerstone for categorising heart failure into reduced (HFrEF), mid-range (HFmrEF) and preserved (HFpEF) phenotypes. Far from being static, EF varies in response to myocardial injury, neurohormonal activation, comorbid stresses and therapeutic interventions. Tracking these dynamics offers insight into disease progression, guides modification of pharmacological regimens and refines prognostic stratification. In recent years, advances in serial imaging, biomarker profiling and machine-learning algorithms have enhanced resolution of temporal EF changes, revealing subgroups of HFmrEF patients whose prior EF trajectories predict distinct risks of mortality and rehospitalisation. At the same time, comparative studies of mineralocorticoid receptor antagonists, renin-angiotensin system inhibitors and neprilysin blockade have clarified treatment responsiveness among patients whose EF lies between 40 and 49 per cent. The interplay between EF fluctuation and coexistent conditions—such as chronic kidney disease, atrial fibrillation and diabetes mellitus—further determines clinical outcomes across the EF spectrum. Integrating dynamic EF assessment with comorbidity profiles promises a more personalised approach to heart failure management, optimising drug selection and timing of device therapies on a global scale.
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Ejection Fraction Dynamics in Heart Failure Management publication trend
The graph below shows the total number of articles in ejection fraction dynamics in heart failure management across all publications each year (not limited to Nature Index journals).
Technical terms
Ejection fraction (EF): The percentage of end-diastolic volume expelled by the left ventricle during systole.
HFrEF, HFmrEF, HFpEF: Subcategories of heart failure defined by EF <40 per cent, 40–49 per cent and ≥50 per cent, respectively.
Renin-angiotensin system inhibitor/angiotensin receptor–neprilysin inhibitor (RASI/ARNI): Classes of agents that reduce neurohormonal activation and improve cardiac remodelling.
Mineralocorticoid receptor antagonist (MRA): Medication that blocks aldosterone receptors to diminish fibrosis and fluid retention.
Neurohormonal blockade: Therapeutic inhibition of maladaptive hormonal pathways, including renin-angiotensin, sympathetic and aldosterone systems.
Biomarker profiling: Measurement of circulating proteins (e.g. natriuretic peptides) to assess myocardial stress and guide therapy.
References
- Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction. Frontiers in Pharmacology (2024).
- Comorbidities and cause-specific outcomes in heart failure across the ejection fraction spectrum: A blueprint for clinical trial design. International Journal of Cardiology (2020).
- Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis. Frontiers in Cardiovascular Medicine (2021).
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