ORIGINAL PAPER Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome Dimitrios Farmakis 1 • Panagiotis Simitsis 1 • Vasiliki Bistola 1 • Filippos Triposkiadis 2 • Ignatios Ikonomidis 1 • Spyridon Katsanos 1 • George Bakosis 1 • Erifili Hatziagelaki 1 • John Lekakis 1 • Alexandre Mebazaa 3 • John Parissis 1 Received: 8 June 2016 / Accepted: 12 December 2016 Ó Springer-Verlag Berlin Heidelberg 2016 Abstract Background Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized pop- ulation as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventric- ular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in- hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. Methods and results The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia. Baseline character- istics, clinical presentation, in-hospital therapies, and short- term mortality (all-cause in-hospital or 30-day mortality, whichever first) were compared among HFrEF (LVEF \ 40%), HFmrEF (LVEF 40–49%), and HFpEF (LVEF C50%) patients. Among 3257 patients with documented LVEF, 52% had HFrEF, 25% HFmrEF, and 23% HFpEF. Patients with HFmrEF had a distinct demographic and clinical profile with many intermediate features between HFrEF and HFpEF. In addition, they had a higher preva- lence of hypertension (p \ 0.001), a lower prevalence of chronic renal disease (p = 0.003), more hospitalizations for acute coronary syndrome (p \ 0.001), or infection (p = 0.003), and were more frequently treated with intra- venous vasodilators compared to HFrEF or HFpEF. Adjusted short-term mortality in HFmrEF was lower than HFrEF [hazard ratio (HR) = 0.635 (0.419, 0.963), p = 0.033] but similar to HFpEF [HR = 1.026 (0.605, 1.741), p = 0.923]. Conclusion Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF. Keywords Acute heart failure Á Intermediate left ventricular ejection fraction Á Hospitalized heart failure patients Á Prognosis Introduction A noteworthy number of patients with heart failure (HF) are characterized by mildly impaired left ventricular ejec- tion fraction (LVEF), ranging between 40 and 50%. These patients with intermediate or mid-range LVEF (HFmrEF) have hitherto been considered suffering from either HF with reduced (HFrEF) or preserved LVEF (HFpEF), depending on the LVEF cutoffs used in clinical trials, observational studies or registries [1–12]. As a result, evidence on HFmrEF remains limited and comes only from secondary analyses of two clinical trials and a community- Electronic supplementary material The online version of this article (doi:10.1007/s00392-016-1063-0) contains supplementary material, which is available to authorized users. & John Parissis jparissis@yahoo.com 1 Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462 Athens, Greece 2 Department of Cardiology, Larissa University Hospital, Larissa, Greece 3 Department of Anesthesiology and Intensive Care, Lariboisie `re University Hospital, Assistance Publique- Ho ˆpitaux de Paris, Universite ´ Paris Diderot, Paris, France 123 Clin Res Cardiol DOI 10.1007/s00392-016-1063-0