Heart failure with normal LVEF in BIOSTAT-CHF

Lukas Baumhove (Lead / Corresponding author), Jasper Tromp, Sylwia Figarska, Bart J. van Essen, Stefan D. Anker, Kenneth Dickstein, John G. Cleland, Chim C. Lang, Gerasimos Filippatos, Leong L. Ng, Nilesh J. Samani, Marco Metra, Dirk J. van Veldhuisen, Carolyn S. P. Lam, Adriaan A. Voors, Peter van der Meer

Research output: Contribution to journalArticlepeer-review

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Aims: Several studies have shown that heart failure (HF) drug treatment seems to benefit patients with preserved ejection fraction (HFpEF) and a left ventricular ejection fraction (LVEF) up to 55–60% but not with higher LVEF. Certain HF drugs are now indicated in patients with HFpEF and a LVEF below normal. However, not much is known about patients with a normal LVEF. Therefore, we investigated the prevalence, clinical characteristics and outcome of patients with HF and a normal LVEF.

Methods and results: Normal LVEF was defined according to the Recommendations for Cardiac Chamber Quantification from the American Society of Echocardiography as a LVEF ≥62% for men and ≥ 64% for women. Preserved ejection fraction was defined as a LVEF ≥50% and reduced ejection fraction as a LVEF <50%. In the total cohort of 1568 studied patients with heart failure (mean age 73 years; 33.6% female) 57 patients (3.6%) had a normal LVEF. These patients least likely had a previous myocardial infarction (p < 0.001) or diabetes (p = 0.045), had the lowest Left Ventricular End Diastolic Diameter (p < 0.001), the highest rate of previous HF hospitalization in the last year (p = 0.015), the highest cardiac output (p < 0.001) and were most frequently women (p < 0.001). Patients with a normal LVEF had the lowest risk for the primary combined outcome of all-cause mortality and HF hospitalization.

Conclusion: Only 3.6% of patients with HF had a sex-adjusted normal LVEF. Despite the sex-adjusted cut-offs they were more frequently female with less ischemic heart disease, higher cardiac output and better clinical outcomes.

Original languageEnglish
Pages (from-to)85-90
Number of pages6
JournalInternational Journal of Cardiology
Early online date29 May 2022
Publication statusPublished - Oct 2022


  • Heart failure
  • Women
  • LVEF
  • Normal LVEF

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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