European Journal of Cardiovascular Medicine

Introduction: HF occurs in a mid-range ejection or moderately decreased ejection fraction. HFmrEF falls between 40 and 49%. An intermediate clinical entity, it is separate from HFpEF and HFrEF, yet it overlaps with both of these conditions. Methods: Record of A total 165 patients analysed for this study. Researchers compared individuals with heart failure who had varying ejection fractions via the use of a retrospective cohort study. This paper investigates the epidemiology, clinical features, prognosis, and management of HFmrEF. Results: The findings indicate that individuals with HFmrEF, which account for 10–25% of all occurrences of heart failure, have clinical characteristics that are a combination of HFpEF and HFrEF, and they have a high incidence of ischemic heart disease. It is important to note that while HFmrEF has a reduced risk of cardiovascular events compared to HFrEF, it has a risk of non-cardiovascular adverse events that is comparable to or even greater. Therapeutic responses point to the possibility of the effectiveness of medications that are HFrEF, such as inhibitors. Conclusion: HFmrEF is a helpful clinical category that brings to light the need of individualized research and treatment methods by emphasizing the need for such tactics. The phrase "mildly diminished EF" is more accurate in describing its features and provides support for treatment strategies that are more focused.

Heart failure (HF) is a significant cardiovascular condition associated with high morbidity and mortality. Iron deficiency is prevalent among HF patients and has been linked to worsened outcomes. Recent studies suggest that correcting iron deficiency may enhance functional capacity and reduce hospitalizations. Additionally, red cell distribution width (RDW) has emerged as a cost-effective prognostic marker in HF. This study aims to explore the relationship between iron parameters—including serum ferritin, total iron-binding capacity (TIBC), and RDW—and the severity of heart failure in patients diagnosed with heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).  Material and Methods: A cross-sectional study was conducted at a tertiary care center, enrolling 180 adult patients diagnosed with heart failure through echocardiography. Data on demographics, clinical history, symptoms, and iron profiles (serum iron, ferritin, TIBC, and RDW) were collected. The severity of heart failure was classified using the New York Heart Association (NYHA) criteria. Statistical analysis was performed using SPSS version 21.0, with descriptive statistics, ANOVA, and Student’s ttests applied to assess significant differences.  Results: The cohort had a mean age of 58.36 years, with 62.8% diagnosed with HFrEF. Serum iron, ferritin, and TIBC levels significantly decreased with increasing severity of HF (p < 0.05). RDW exhibited a notable upward trend correlating with NYHA classification (p < 0.001). There were no significant differences in TIBC and unsaturated iron-binding capacity across severity levels. A significant negative correlation was observed between patient age and RDW (r = -0.316, p < 0.003).  Conclusion: The findings highlight that heart failure is associated with significant alterations in serum iron parameters, especially as HF severity increases. RDW serves as an effective and economical prognostic marker, suggesting that screening for iron deficiency in HF patients may improve clinical outcomes and reduce rehospitalization rates.

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) poses a significant clinical challenge due to its complex pathophysiology and increasing prevalence, particularly among older adults. Despite normal or near-normal left ventricular ejection fraction, patients exhibit heart failure symptoms such as dyspnea and fatigue. HFpEF is commonly associated with comorbidities like hypertension, diabetes, and obesity, which complicate management and contribute to poor prognosis. Methods: A descriptive observational study was conducted over two years at a tertiary care hospital in Chhattisgarh. The study included 100 adult patients diagnosed with HFpEF, defined by symptoms of heart failure, left ventricular ejection fraction (LVEF) ≥ 50%, and without evidence of structural or cardiovascular heart disease. Clinical evaluation, laboratory tests, and imaging studies, including echocardiography, were performed to assess cardiac function. Statistical analysis was conducted using descriptive statistics, t-tests, and chi-square tests. Results: The study participants had a mean age of 56.72 years, with a balanced gender distribution. Fatigue (87%) and dyspnoea (82%) were the most common symptoms. Hypertension (88%) and diabetes (67%) were prevalent comorbidities. The mean ejection fraction was 54.53%, with mild diastolic dysfunction observed in 78% of patients. Conclusion: HFpEF primarily affects older adults with significant comorbidities, notably hypertension and diabetes. Although ejection fraction remains normal, mild diastolic dysfunction is common. These findings emphasize the need for comprehensive management strategies focusing on symptom relief and comorbidity control to improve patient outcomes.

Background: Heart Failure with Preserved Ejection Fraction (HFpEF) is a growing clinical challenge globally, especially among elderly patients with multiple comorbidities. Indian data on its clinical profile and outcomes remain limited. Aim: To evaluate the clinical characteristics and short-term outcomes of patients diagnosed with HFpEF in a tertiary care hospital. Methods: A prospective observational study was conducted on 100 patients with HFpEF (LVEF ≥ 50%). Clinical presentation, comorbidities, echocardiographic findings, and 30-day outcomes were recorded and analyzed using descriptive and inferential statistics. Results: HFpEF was more common in elderly females (mean age 66 years). Hypertension (82%), diabetes (61%), and obesity (66%) were the most prevalent comorbidities. Echocardiography showed diastolic dysfunction, left atrial enlargement (64%), and LV hypertrophy (57%). At 30 days, 84% improved symptomatically, while 11% were readmitted, and 5% died, with worse outcomes among those with diabetes, atrial fibrillation, and CKD (p < 0.05). Conclusion: HFpEF patients frequently present with multiple comorbidities that contribute to early adverse outcomes. Targeted management of risk factors and structured follow-up are crucial for improving prognosis in these patients.

Introduction: Right ventricular dysfunction (RVD) is increasingly recognized in heart failure with preserved ejection fraction (HFpEF) and may impact prognosis. This study was aimed to assess the prevalence of RVD in HFpEF patients and its association with clinical outcomes. Methods: The current prospective observational study was done on of 100 HFpEF patients. Clinical, biochemical, and echocardiographic parameters, including TAPSE, FAC, and PASP, were evaluated. Patients were categorized into RVD and non-RVD groups and compared for clinical features, hospital stay, and one-month mortality. Results: RVD was present in 41% of patients. Age, gender, BMI, and comorbidities were similar between patients with and without RVD. RVD patients had lower EF, TAPSE, and FAC, and higher PASP. RVD was associated with longer hospital stay (7.3 vs. 5.4 days) and more mortality (8 of 13 deaths). Conclusion: RVD is common in HFpEF and is linked to worse short-term outcomes. Routine assessment of RV function may aid in risk stratification and management of HFpEF.

Introduction: Diastolic dysfunction (DD) is a prevalent cause of heart failure with preserved ejection fraction, and conventional echocardiographic parameters have recognized limitations in early detection. Left atrial strain (LASr) measured by two-dimensional speckle-tracking echocardiography is emerging as a sensitive marker of impaired diastolic function. Aim: To evaluate left atrial strain as a predictor of diastolic dysfunction in patients undergoing echocardiographic assessment. Methods: In this cross-sectional study, 120 adult patients with preserved left ventricular ejection fraction (≥50%) and sinus rhythm underwent transthoracic echocardiography. Conventional diastolic parameters were assessed as per ASE/EACVI 2016 guidelines. LASr, conduit strain (LAScd), and contraction strain (LASct) were measured using apical four-chamber speckle-tracking analysis. Diastolic dysfunction was graded from 0 (normal) to III (severe). Statistical analyses included t-tests, chi-square tests, correlation analysis, and ROC curve evaluation. Results: Diastolic dysfunction was present in 43.3% of patients (n=52). Mean LASr was significantly lower in the DD group compared to those without DD (21.6 ± 5.4% vs 37.8 ± 6.2%; p<0.001). LASr <24% predicted DD with an odds ratio of 23.65 (95% CI: 8.76–63.89, p<0.001). LASr showed a strong negative correlation with DD severity (Spearman’s ρ=−0.82, p<0.001), decreasing progressively from normal to Grade III dysfunction. Conventional indices (E/A ratio, e′ velocities, E/e′, TR velocity, LAVI) also differed significantly between groups, while LVEF remained preserved. Conclusion: Left atrial reservoir strain is a strong, independent echocardiographic predictor of diastolic dysfunction and its severity in patients with preserved ejection fraction, offering added diagnostic value alongside conventional parameters. Incorporating LASr into routine echocardiographic evaluation may improve early detection and grading of diastolic dysfunction.

Background: Type 2 diabetes mellitus (T2DM) is a major risk factor for heart failure (HF), and the two conditions frequently coexist, leading to a synergistic increase in morbidity and mortality. While the prognostic implications are well-established, detailed comparative analyses of the clinical phenotype at presentation are needed to guide targeted management. Methods: We conducted a prospective, single-center, observational cohort study involving 400 patients with a primary diagnosis of HF, enrolled between January 2021 and December 2022. Patients were divided into two groups: HF-T2DM (n=185) and HF-non-DM (n=215). Data on demographics, clinical parameters, New York Heart Association (NYHA) functional class, comorbidities, laboratory biomarkers (NT-proBNP, HbA1c, eGFR), and echocardiographic findings (LVEF, diastolic function) were collected and analyzed. Independent t-tests and Chi-square tests were used for statistical comparison. Key Findings: The HF-T2DM group, compared to the HF-non-DM group, was characterized by a higher body mass index (31.2 ± 4.5 vs. 28.1 ± 3.9 kg/m², p<0.001) and a greater proportion of patients in NYHA functional class III/IV (65.4% vs. 48.8%, p=0.002). The HF-T2DM cohort exhibited significantly higher levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (3450 ± 1280 vs. 2150 ± 990 pg/mL, p<0.001) and worse renal function (mean eGFR 55.4 ± 15.2 vs. 68.3 ± 16.5 mL/min/1.73m², p<0.001). Echocardiographically, heart failure with preserved ejection fraction (HFpEF) was significantly more prevalent in the HF-T2DM group (61.1% vs. 42.8%, p=0.001). Furthermore, comorbidities such as hypertension (88.1% vs. 72.1%, p<0.001) and chronic kidney disease (45.9% vs. 27.0%, p<0.001) were more common in diabetic patients. Conclusion: Patients with heart failure and T2DM present with a more adverse clinical phenotype characterized by worse functional status, greater fluid retention, higher cardiac wall stress, impaired renal function, and a higher prevalence of HFpEF and comorbidities. These findings highlight the distinct pathophysiology of diabetic heart disease and underscore the need for integrated, multi-system management strategies for this high-risk population.

Background: Diabetes mellitus is an established cause of subclinical myocardial involvement, frequently manifesting as left ventricular diastolic dysfunction (LVDD) before the onset of overt cardiovascular disease. Diabetic cardiomyopathy is characterized by impaired myocardial relaxation and increased ventricular stiffness, leading to elevated filling pressures while systolic function remains preserved. As this condition often remains asymptomatic for prolonged periods, early identification of LVDD is essential to prevent progression to heart failure with preserved ejection fraction. Despite the high prevalence of diabetes in India, region-specific data from central India on echocardiographic assessment of diastolic dysfunction remain limited. Objectives: To evaluate left ventricular diastolic function in patients with type 2 diabetes mellitus using transthoracic echocardiography and to determine the prevalence, grades, and independent predictors of diastolic dysfunction at a tertiary care centre in Nagpur. Methods: This hospital-based cross-sectional study was conducted over one year at a tertiary care centre in Nagpur and included 220 adult patients with type 2 diabetes mellitus and preserved systolic function. Patients with ischemic heart disease, significant valvular disease, cardiomyopathy, arrhythmias, or left ventricular ejection fraction <50% were excluded. All participants underwent clinical evaluation, laboratory assessment including HbA1c, and transthoracic echocardiography. Left ventricular diastolic function was assessed using Doppler and tissue Doppler parameters and graded according to the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Results: Left ventricular diastolic dysfunction was identified in 95 patients (43.2%). Grade I diastolic dysfunction was the most common pattern (26.4%), followed by Grade II (11.4%) and Grade III (5.4%). Patients with LVDD were significantly older and had a longer duration of diabetes, higher body mass index, higher prevalence of hypertension, and poorer glycaemic control compared to those with normal diastolic function (p < 0.05). Left ventricular ejection fraction was preserved and comparable between groups. On multivariate analysis, advancing age, longer duration of diabetes, hypertension, HbA1c ≥8%, and increased body mass index emerged as independent predictors of diastolic dysfunction. Conclusion: Diastolic dysfunction is common among patients with type 2 diabetes mellitus despite preserved systolic function. Routine echocardiographic screening in high-risk diabetic patients may enable early detection and targeted intervention, potentially reducing progression to symptomatic heart failure