LVEF has an important role in the classification of patients with HF because of differing prognosis and response to treatments. In the guideline of 2022 AHA, HFrEF is defined as LVEF ≤40% . HF with preserved EF (HFpEF) including approximately 50% of the population with HF with increased prevalence. HFpEF is defined as LVEF ≥50%. Heaet failure improved EF is considered when follow-up LVEF reaches more than 40%.
Diastolic Dysfunction: The left ventricular ejection fraction is preserved in diastolic dysfunction and there is an abnormality in myocardial relaxation or excessive myocardial stiffness. Systolic and diastolic dysfunction commonly occur in conjunction with each other.
2. Left-, Right- and Biventricular Failure[edit | edit source]
Another common method of classifying heart failure is based upon the ventricle involved.
Left-ventricular Heart Failure: There is impaired left ventricular function with the reduced flow into the aorta.
Right-ventricular Heart Failure: There is impaired right ventricular function with the reduced flow into the pulmonary artery and lungs.
Biventricular Failure: The most common cause of right heart failure is left heart failure, and mixed presentations are common, especially when the cardiac septum is involved.
3. High output versus Low output Heart Failure[edit | edit source]
Low Output Failure: The cardiac output is reduced, and the systemic vascular resistance (SVR) is high. In low output failure, there is an inadequate supply of blood flow to meet normal metabolic demands.
Acute or Decompensated: Acute or decompensated heart failure is a term used to describe exacerbated or decompensated heart failure, and refers to an episode in which a patient sustains a change in heart failure signs and symptoms that necessitates urgent therapy or hospitalization.[6]
Chronic: There is stable symptomatology in chronic heart failure.
Marked limitation of physical activity.
Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
The ACC/AHA classification system was introduced to emphasize the natural history of the heart failure syndrome and to identify opportunities to intervene earlier and prevent disease progression.
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Stages of Heart Failure
Stages
Definition
Example
Corresponding NYHA class
A
Patients at high risk for developing HF but without structural heart disease or symptoms of heart failure or biomarkers within normal ranges.
Patients without current or previous sings/ symptoms of HF but evidence of the following:
Structural heart diseases.
Increased filling pressures in the heart.
Increased levels of Natriuretic peptide.
Persistently elevated cardiac diagnosis with no diagnosis.
NYHA class I
C
Patient with past or current symptoms/ signs of HF
The trajectory of Stage C HF:
New onset/ De Novo HF
Resolution of symptoms
Persistent HF
Worsening HF
NYHA classes I, II, III, and IV
D
Profound HF symptoms.
Patients have symptoms that interfere with daily life activities. They may also have recurrent hospitalizations despite attempts to optimize guideline-directed medical therapy.
↑McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID34447992Check |pmid= value (help). Vancouver style error: initials (help)
↑Jessup. M, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. Circulation. 2009 Apr 14;119(14):1977-2016. PMID 19324967