ArticleClinical research in cardiology : official journal of the German Cardiac Society2025
Heart failure with supranormal ejection fraction: clinical characteristics and outcomes compared to mildly reduced and preserved ejection fraction.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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7 citing papers in PubMed.
- Phenotyping Heart Failure: Looking Beyond Left Ventricular Ejection Fraction.Mayo Clinic proceedings. Innovations, quality & outcomes · 2026Article
- Supranormal Ejection Fraction as a Clinical Red Flag: Differentiating Hemodynamic Stress From Intrinsic Cardiomyopathy in Heart Failure.Mayo Clinic proceedings. Innovations, quality & outcomes · 2026Article
- Heart Failure with Supranormal Ejection Fraction: An Emerging High-Risk Phenotype Within the Preserved Ejection Fraction Spectrum-A Systematic Review.Journal of clinical medicine · 2026Review
- Heart failure in 2025: new insights, therapies, and clinical directions.Journal of thoracic disease · 2026Review
- Restrictive filling pattern of transmitral inflow in acute decompensated heart failure with preserved ejection fraction: insights from the KCHF registry.Open heart · 2026Observational
- Central Adiposity or Hypertension: Which Drives Heart Failure With a Preserved Ejection Fraction?Journal of the American College of Cardiology · 2025Review
- Prognostic value of left atrioventricular coupling index assessed by 3D echocardiography in patients with chronic kidney disease and heart failure with preserved ejection fraction.BMC cardiovascular disorders · 2025Article
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9 authors.
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Abstract
backgroundLittle is known about the recently emerging entity, heart failure with supranormal ejection fraction (HFsnEF).
objectiveTo describe the clinical characteristics and outcome of HFsnEF, compared to HF with mildly reduced EF (HFmrEF) and HF with preserved EF (HFpEF) patients.
designA single center retrospective analysis. PATIENTS: Hospitalized and ambulatory heart failure (HF) patients who underwent echocardiography with left ventricular ejection fraction (LVEF) > 40%. MAIN MEASURES: Clinical and echocardiographic parameters, hospitalization rates and mortality. KEY
resultsA total of 6,202 patients (mean age 81.4 ± 14.1 years, 52% females) were analyzed: 750 in the HFmrEF group (LVEF 41-49%), 4360 in the HFpEF group (LVEF 50-64%), and 1092 in the HFsnEF group (LVEF ≥ 65%). Patients were followed for a median of 32 (11-65) months. HFsnEF patients were older, predominantly female, exhibited higher hypertension prevalence, more severe LV hypertrophy, smaller LV dimensions, and higher filling pressures compared to the other groups (p < 0.001 for all). These features were consistent in both hospitalized and ambulatory patients. In a univariable model, HFsnEF patients had higher mortality rates compared to HFmrEF and HFpEF patients (HR 1.258, 95% CI 1.117-1.418; p < 0.001 and HR 1.112, 95% CI 1.023-1.208; p = 0.012, respectively). However, in a multivariable model, adjusted for age, sex, comorbidities, and echocardiographic parameters, there was no significant difference in the mortality rates between all groups. The total hospitalization rate was similar between the HFpEF and HFsnEF groups, and lower in the HFmrEF group (p = 0.022). However, the HFsnEF group had the lowest rate of HF-related hospitalizations (p = 0.002).
conclusionHFsnEF represents a group of patients with a distinct clinical and echocardiographic profile accompanied by worse outcomes, likely mediated by older age and a higher comorbidity burden, compared to HFmrEF and HFpEF. Therefore, the supranormal EF may serve as a marker rather than an independent prognostic factor.
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