Heart failure with mid-range ejection fraction and the effect of β-blockers after acute myocardial infarction

Pil Sang Song, Mijoo Kim, Seok Woo Seong, Jae Hyeong Park, Si Wan Choi, Joo Yong Hahn, Hyeon Cheol Gwon, Seung Ho Hur, Seung Woon Rha, Chang Hwan Yoon, Myung Ho Jeong, In Whan Seong, Jin Ok Jeong

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


There is currently an ongoing debate about the ‘grey area’ of heart failure with mid-range ejection fraction (HFmrEF). We evaluated characteristics, prognosis, and the effect of β-blockers on clinical outcomes in patients with HFmrEF after acute myocardial infarction (AMI). We included a total of 10,785 patients and divided them into three groups: EF 40–49% (HFmrEF; n = 2717; reference); EF < 40% (reduced EF [HFrEF]; n = 1194); and EF ≥ 50% (preserved EF [HFpEF]; n = 6874). The primary outcome was 2-year all-cause mortality. HFmrEF was intermediate between HFrEF and HFpEF for baseline characteristics. The risk of all-cause mortality was lower for HFmrEF patients compared to HFrEF patients (adjusted hazard ratio [HR] 0.710; 95% confidence interval [CI] 0.544–0.927; P = 0.012). However, HFmrEF patients tended to be at higher risk for 2-year all-cause mortality than HFpEF patients (adjusted HR 1.235; 95% CI 0.989–1.511; P = 0.090). β-blockers were associated with reductions in all-cause mortality for the entire cohort (adjusted HR 0.760; 95% CI 0.592–0.975; P = 0.031). β-blockers were effective in patients with HFrEF (adjusted HR 0.667; 95% CI 0.471–0.944; P = 0.022), tended to be effective in patients with HFmrEF (adjusted HR 0.665; 95% CI 0.426–1.038; P = 0.072), but not effective in patients with HFpEF (adjusted HR 0.852; 95% CI 0.548–1.326; P = 0.478; interaction P = 0.026). In conclusion, clinical profiles and prognosis of patients with post-AMI HFmrEF are largely intermediate between HFrEF and HFpEF. β-blockers reduced or tended to reduce 2-year all-cause mortality in patients with HFrEF or HFmrEF, respectively, but not those with HFpEF after AMI.

Original languageEnglish
Pages (from-to)1848-1855
Number of pages8
JournalHeart and Vessels
Issue number12
Publication statusPublished - 2021 Dec

Bibliographical note

Funding Information:
This work was supported by research fund of Chungnam National University.

Publisher Copyright:
© 2021, Springer Japan KK, part of Springer Nature.


  • Acute myocardial infarction
  • Heart failure with mid-range ejection fraction
  • β-blockers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Heart failure with mid-range ejection fraction and the effect of β-blockers after acute myocardial infarction'. Together they form a unique fingerprint.

Cite this