Anca Andreea ANDRONIC, Sorina MIHAILA and Mircea CINTEZA

ABSTRACT

Heart failure with midrange ejection fraction (HFmrEF) is a new category of heart failure (HF), inbetween HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
Previous studies were mainly conducted in HFrEF patients having a left ventricle ejection fraction (LVEF) lower than 35-40%. Later on, HFpEF captured the spot-light of the research field, and studies focused on patients with HF symptoms, but with a LVEF exceeding 50%.
Consequently, a gap of knowledge comprising the LVEF between 40 and 49% has arisen. Current studies focusing on patients with HFmrEF are arguing the same conclusions or even having contradictory findings.
HFmrEF has a prevalence of 10-20% of HF patients. HFmrEF has distinct, but intermediate clinical, structural and functional characteristics, as well as intermediate outcomes in comparison with HFrEF and HFpEF. However, there is still a large gap in evidence regarding detailed hemodynamic characteristics, long-term follow-up and optimal therapeutic options for these patients.
Extensive research was recommended in order to improve knowledge about this “gray area” of patients with HF. Therefore, we aimed to provide an over-view of the existing and lacking data regarding patients
with HFmrEF.
Keywords: Heart failure, mid range ejection fraction

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Raluca Ileana MINCU, Lucia Stefania MAGDA, Maria FLORESCU, Andreea VELCEA, Sorina MIHAILA, Diana MIHALCEA, Bogdan O. POPESCU, Adela CHIRU, Cristina TIU, Mircea CINTEZA and Dragos VINEREANU

ABSTRACT

Multiple sclerosis (MS) is a chronic neurological condition, characterized by recurrent episodes of inflammation and demyelination of the central nervous system called relapsing-remitting episodes, and continuous axonal degeneration that leads to irreversible progressive invalidity.

Patients with multiple sclerosis present a higher mortality rate compared to the general population, and the excess of mortality may be explained by the increased cardiovascular risk and occurrence of cardiovascular disease. However, the exact pathways to cardiovascular dysfunction are not yet completely elucidated.

This review focuses on the most important mechanisms of cardiovascular dysfunction in MS, such as the cardiomyocite structure alteration, the cardiovascular autonomous nervous system dysfunction, physical invalidity, oxidative stress and endothelial dysfunction, as well as the impact of cardiovascular risk factors in MS.

The latest evidence about therapeutic approaches for MS, such as immunomodulatory treatment, vitamin D supplementation and statins are also discussed.

There is little knowledge about the cardiovascular dysfunction in MS, and further research is required to improve the understanding of these complex mechanisms.

Keywords: multiple sclerosis, cardiovascular dysfunction, immunonodulatory treatment

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