Non-invasive Multimodality Cardiovascular Imaging of the Right Heart and Pulmonary Circulation in Pulmonary Hypertension



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New Joint Scientific Statement On Ejection Fraction Released By Leading Heart Failure Organizations

The Heart Failure Society of America (HFSA), the Heart Failure Association of the European Society of Cardiology (HFA of the ESC), and the Japanese Heart Failure Society (JHFS) announced today a new joint scientific statement titled The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure.

The statement is published in the European Journal of Heart Failure.

Left ventricular ejection fraction (LVEF) has long served as a central measure in assessing cardiac function and guiding heart failure (HF) management. However, limitations in its diagnostic precision, reproducibility, and relevance across the full spectrum of HF phenotypes have prompted experts to re-evaluate its role. This new statement, developed by an international panel of 21 HF experts through the Trilateral International Consensus Conference (TICC), offers a comprehensive reassessment of the use of LVEF and introduces a dynamic, trajectory-based framework for classifying and managing HF.

The Use of Left Ventricular Ejection Fraction in the Diagnosis and Management of Heart Failure statement offers expert consensus and guidance for clinicians on key areas of HF diagnosis and treatment, with a particular focus on:

  • Historical context and evolution of LVEF as a measure
  • Limitations of current LVEF-based classification systems
  • The role of LVEF trajectories in diagnosis, prognosis, and therapy selection
  • Emerging imaging techniques and biomarkers for myocardial characterization
  • Therapeutic implications across the full spectrum of LVEF, including supra-normal EF
  • Future directions in HF stratification and management

    • Despite widespread reliance on single-point LVEF measurements to define heart failure phenotypes such as HFrEF, HFmrEF, and HFpEF, evidence increasingly shows that these static categories may oversimplify the complex and evolving nature of HF. This joint statement emphasizes a shift toward classification based on LVEF trajectories—such as persistently reduced, worsening, or improved LVEF—which provide more accurate prognostic insights and treatment implications.

    "The static categorization of heart failure based on a single LVEF cut-off doesn't capture the dynamic progression or response to therapy in many patients," said John Teerlink, MD, FHFSA, co-author and TICC co-chair representing HFSA. "By focusing on LVEF trajectories, clinicians can make more informed treatment decisions and provide more personalized care. Additionally, there are beneficial therapies that can be initiated in patients with heart failure without knowledge of the LVEF."

    The statement also highlights the importance of effective therapies across the full range of LVEF, particularly SGLT2 inhibitors, which demonstrate robust outcomes regardless of EF values, and calls for continued research into novel imaging modalities and myocardial biomarkers that may further refine patient stratification and targeted treatment.

    This joint scientific statement was created through the TICC, hosted by the HFA of the ESC in collaboration with the HFSA and JHFS. Giuseppe Rosano (HFA of the ESC), John R. Teerlink (HFSA), and Koichiro Kinugawa (JHFS) served as co-chairs. The TICC brings together leaders from global heart failure societies to develop key scientific statements in the field.

    More information:Giuseppe M.C. Rosano et al, The use of left ventricular ejection fraction in the diagnosis and management of heart failure. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC, the Heart Failure Society of America (HFSA), and the Japanese Heart Failure Society (JHFS), European Journal of Heart Failure (2025). DOI: 10.1002/ejhf.3646

    Provided by European Society of Cardiology

    Citation: New joint scientific statement on ejection fraction released by leading heart failure organizations (2025, April 22) retrieved 24 April 2025 from https://sciencex.Com/wire-news/506795621/new-joint-scientific-statement-on-ejection-fraction-released-by.Html

    This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.


    ESC22: AstraZeneca's Farxiga DELIVERs In Heart Failure

    AstraZeneca's Farxiga reduced the risk of hospitalisation and death in people with all types of heart failure in the DELIVER trial, which could dramatically increase the population of patients eligible for treatment with the SGLT2 inhibitor.

    The study showed that treatment with Farxiga (dapagliflozin) led to an 18% reduction in cardiovascular death or worsening heart failure in patients with both mildly reduced and preserved ejection fraction, said AZ.

    Ejection fraction is a measure of how much blood the left ventricle of the heart pumps out with each contraction, with the normal range around 50% to 75%.

    That is in the same vicinity as the results seen with Boehringer Ingelheim's rival SGLT2 inhibitor Jardiance (empagliflozin) in the EMPEROR-Preserved in July 2021 in heart failure preserved ejection fraction (HFpEF).

    Farxiga – known as Forxiga in some markets – has been beating a trail for the SLGT2 inhibitor class in heart failure, extending their use beyond diabetes.

    It was approved to reduce hospitalisation in heart failure patients in 2019, and then got the go-ahead for use in patients with heart failure with reduced ejection fraction (HFrEF) in 2020 on the strength of the DAPA-HF study.

    Those indications has helped drive quarterly sales of the drug above the $1 billion threshold, but growth has been threatened by approvals of Jardiance for both HFrEF and HFpEF in recent months, making it an option for all heart failure patients.

    In particular, the readout of EMPEROR-Preserved handed an advantage to Jardiance in HFpEF, which accounts for around half of all heart failure cases and is notoriously hard to treat effectively. Now, AZ has an opportunity to redress the balance.

    Along with the 18% reduction in the composite endpoint, Farxiga also cut cardiovascular death by 14% and death from any case by 10% in patients, regardless of their rejection fraction, in a combined analysis of the DAPA-HF and DELIVER trials.

    According to AZ, Farxiga is the first drug to show a mortality benefit "across the full ejection fraction range."

    After the EMPEROR-Preserved results emerged – with a 21% reduction in the composite endpoint overall – there was some concern about a lack of efficacy among patients with normal-range ejection fractions (65% or greater).

    "These results underpin the valuable role dapagliflozin can play in clinical practice, as we can initiate treatment right away while waiting for ejection fraction to be measured," said Prof John McMurray, deputy director of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, UK.

    Novartis' blockbuster Entresto (sacubitril/valsartan) has also been approved in the US for both HFrEF and HFpEF, but so far has not had its labelling extended beyond HFrEF in the EU.

    Overall, the data for Entresto in HFpEF looks weaker than for the SGLT2 drugs, although with different mechanisms of action there is potential for combination use.

    With two large-scale trials showing a mortality benefit in hand, it looks assured that SGLT2 inhibitors will become a standard part of the treatment armamentarium for heart failure patients.

    AZ meanwhile has first mover advantage in chronic kidney disease (CKD) – another potentially lucrative market for SGLT2 drugs – having secured approval for Farxiga in that indication.

    Boehringer and Lilly on the other hand recently reported a first-in-class win for Jardiance in acute heart failure (AHF).


    AZ Trumpets Farxiga Survival Data In Renal Disease At ESC 2020

    AstraZeneca's Farxiga is already ahead of rivals in the SGLT2 inhibitor field in heart failure, and now looks set to repeat that success in renal disease after reporting stellar results from the DAPA-CKD trial.

    AZ halted DAPA-CKD in July after revealing that Farxiga (dapagliflozin) met its objective of slowing the worsening of renal function and cut the risk of death in patients with chronic kidney disease (CKD) with and without type 2 diabetes. 

    Now, detailed findings presented at the European Society of Cardiology (ESC) meeting over the weekend showed just how well the drug performed, and have the potential to "transform the standard of care" in patients with CKD, according to the trial investigators.

    Adding Farxiga to standard therapy resulted in a 39% reduction in the composite measure of worsening renal function or death due to cardiovascular or kidney disease compared to placebo, DAPA-CKD's primary endpoint. It also hit all secondary objectives, notably achieving a 31% cut in the chance of dying from any cause.

    CKD is a progressive condition that affects almost 700 million people around the world, but has limited treatment options other than old drugs like ACE inhibitors and angiotensin 2 receptor antagonists. That unmet need prompted the FDA to award Farxiga fast-track status in CKD last year.

    There were already signs from cardiovascular outcome studies that SGLT2 inhibitors like Farxiga and Boehringer Ingelheim/Eli Lilly's Jardiance (empagliflozin) could preserve renal function in type 2 diabetics.

    However, DAPA-CKD is the first large-scale trial to test an SGLT2 specifically in both diabetic and non-diabetic patients with CKD, and showing a clear and sizeable impact on survival goes beyond expectations.

    Mene Pangalos, executive vice president of biopharmaceuticals R&D at AZ, who described the data as showing "overwhelming efficacy" when the top-line result was released in July, said that AZ would now be sharing the DAPA-CKD results with regulators around the world.

    Farxiga is at the forefront of widening the use of SGLT2 inhibitors beyond their traditional role as treatments for type 2 diabetes.

    The company already picked up approvals for Farxiga to reduce the risk of hospitalisation in heart failure patients with type 2 diabetes, and as a standalone treatment for heart failure with reduced ejection fraction (HFrEF) in patients with and without diabetes.

    At ESC 2020 Boehringer and Lilly showed off positive results with Jardiance in in the EMPEROR-REDUCED trial in HFrEF that could allow it to challenge Farxiga's first in class approval for that indication, with filings possible within the next few months. It also suggests that the impact of SGLT2 drugs in heart failure could be a class effect.

    In the meantime, Farxiga looks on course to secure the first approval for an SGLT2 inhibitor in CKD as well, although Boehringer and Lilly are in hot pursuit, claiming a fast-track designation from the FDA for Jardiance in that indication in March.

    The two partners are carrying out the EMPA-KIDNEY trial in CKD patients with and without diabetes, with results due in 2022 – unless like DAPA-CKD the trial is halted early.





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