p.15 抽出テキスト

.................................................................................................................. therapies to those with LVEF <_40%.813 This supports the renaming of HFmrEF from ‘heart failure with mid-range ejection fraction’ to ‘heart failure with mildly reduced ejection fraction’.14

• Those with symptoms and signs of HF, with evidence of structural and/or functional cardiac abnormalities and/or raised natriuretic peptides (NPs), and with an LVEF >_50%, have HFpEF. The diagnosis of HFrEF, HFmrEF, and HFpEF is covered in more detail in their respective sections (sections 5, 7, and 8, respectively). These definitions are consistent with a recent report on the Universal Definition of Heart Failure.15 Patients with non-CV disease, e.g. anaemia, pulmonary, renal, thyroid, or hepatic disease may have symptoms and signs very similar to those of HF, but in the absence of cardiac dysfunction, they do not fulfil the criteria for HF. However, these pathologies can coexist with HF and exacerbate the HF syndrome.

3.2.2 Right ventricular dysfunction Heart failure can also be a result of right ventricular (RV) dysfunction. RV mechanics and function are altered in the setting of either pressure or volume overload.16 Although the main aetiology of chronic RV failure is LV dysfunction-induced pulmonary hypertension, there are a number of other causes of RV dysfunction [e.g. MI, arrhythmogenic right ventricular cardiomyopathy (ARVC), or valve disease].17 The diagnosis is determined by a quantitative assessment of global RV function, most commonly by echocardiography, using at least one of the following measurements: fractional area change (FAC); tricuspid annular plane systolic excursion (TAPSE); and Doppler tissue imaging-derived systolic S0 velocity of the tricuspid annulus. The diagnosis and management of RV dysfunction is covered comprehensively in a recent Heart Failure Association (HFA) position paper.18

3.2.3 Other common terminology used in heart failure Heart failure is usually divided into two presentations: chronic heart failure (CHF) and acute heart failure (AHF). CHF describes those who have had an established diagnosis of HF or who have a more gradual onset of symptoms. If CHF deteriorates, either suddenly or slowly, the episode may be described as ‘decompensated’ HF. This can result in a hospital admission or treatment with intravenous (i.v.) diuretic therapy in the outpatient setting. In addition, HF can present more acutely. Both of these are considered in the section on AHF (section 11).

Some individuals with HF may recover completely [e.g. those due to alcohol-induced cardiomyopathy (CMP), viral myocarditis, Takotsubo syndrome, peripartum cardiomyopathy (PPCM), or tachycardiomyopathy]. Other patients with LV systolic dysfunction may show a substantial or even complete recovery of LV systolic function after receiving drug and device therapy.

3.2.4 Terminology related to the symptomatic severity of heart failure The simplest terminology used to describe the severity of HF is the New York Heart Association (NYHA) functional classification (Table 4). However, this relies solely on symptoms and there are many other better prognostic indicators in HF.19 Importantly, patients with mild symptoms may still have a high risk of hospitalization and death.20 Predicting outcome is particularly important in advanced HF to guide selection of cardiac transplantation and device therapies. This will be covered in detail in the section on advanced HF (section 10).

3.3 Epidemiology and natural history of

heart failure 3.3.1 Incidence and prevalence In developed countries, the age-adjusted incidence of HF may be falling, presumably reflecting better management of CV disease, but due to ageing, the overall incidence is increasing.2124 Currently, the incidence of HF in Europe is about 3/1000 person-years (all age-groups) or about 5/1000 person-years in adults.25,26 The prevalence of HF appears to be 12% of adults.21,2731 As studies only usually include recognized/diagnosed HF cases, the true prevalence is likely to be higher.32 The prevalence increases with age: from around 1% for those aged <55 years to >10% in those aged 70 years or over.3336 It

Table 3 Definition of heart failure with reduced ejection fraction, mildly reduced ejection fraction and preserved ejection fraction

Type of HF HFrEF HFmrEF HFpEF CRITERIA 1 Symptoms ± Signsa Symptoms ± Signsa Symptoms ± Signsa

2 LVEF <_40% LVEF 4149%b LVEF >_50%

3   Objective evidence of cardiac structural and/or functional abnormalities consistent with the presence of LV diastolic

dysfunction/raised LV filling pressures, including raised natriuretic peptidesc

HF = heart failure; HFmrEF = heart failure with mildly reduced ejection fraction; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; LV = left ventricle; LVEF = left ventricular ejection fraction. aSigns may not be present in the early stages of HF (especially in HFpEF) and in optimally treated patients. bFor the diagnosis of HFmrEF, the presence of other evidence of structural heart disease (e.g. increased left atrial size, LV hypertrophy or echocardiographic measures of impaired LV filling) makes the diagnosis more likely. cFor the diagnosis of HFpEF, the greater the number of abnormalities present, the higher the likelihood of HFpEF. ESC 2021 Downloaded from academic.oup.com/eurheartj/article/42/36/3599/6358045 by guest on 07 October 2026