IJCS | Volume 33, Nº1, January / February 2019

50 association with valve disease (OR: 4.61, CI: 1.33-15.96) and kidney disease (OR: 5.18, CI: 1.68-11.98). Discussion Clinical Profile The ICD 12 classification is already well-defined, and its categorization according to LVEF measured by echocardiography is used to characterize the syndrome clinically and, particularly, to orientate the treatment. LVEF through echocardiography is considered easy to perform, of lower cost and can be applied at the bedside, when necessary. However, there are several limitations concerning its estimation, both technical (dependent observer, two-dimensional evaluation, intra- and inter-observer variability and inadequate acoustic window) and non-technical Table 2 - Results of Multivariate analysis for the in-hospital death outcome – p-value Variables EF < 40% P-value EF 40 – 49% p-value EF ≥ 50% p-value OR (CI95%) OR (CI95%) OR (CI95%) Sex - Male - - 0.373 - - Age ≥ 65 years 0.087 - - 0.182 FC IV 0.223 0.090 - - Etiology - - 0.768 - - IC PR - - 0.494 - - Valve disease PR 0.084 4.17 (1.01-9.13) 0.047 4.61 (1.33-15.96) 0.016 Kidney disease PR 2.84 (1.9-6.79) 0.019 0.192 5.18 (1.68-11.98) 0.004 COPD/Asma PR 0.724 - - - - PVD PR 0.120 - - 0.049 Sodium ALT 0.974 0.199 - - Urea ALT 0.914 6.18 (1.78-11.45) 0.004 0.911 Creatinine ALT - - - - 0.412 Aneamia 0.222 0.274 - - BB INT. 0.29 (0.12-0.72) 0.008 0.29 (0.08-0.97) 0.045 - - ACEi/ARB INT. 0.21 (0.09-0.49) 0.001 - - - - SPIR. INT 0.260 0.182 - - Furos. INT 0.068 0.077 - - Note: OR: odds ratio; CI95%: 95% confidence interval. (mitral regurgitation, aortic stenosis, arrhythmias, myocarditis and Takotsubo syndrome), which may generate inaccurate measurements. 13 Cardiac magnetic resonance imaging is considered the gold standard for assessing left ventricular (LV) systolic function, 14 but it is not easily available in daily clinical practice. Although echocardiography does not seem to be the ideal method, it remains a practical and accessible tool for estimation of LVEF and the choice exam in all studies that have focused on HF treatment so far. 15-17 It is worthy to note that classifying HF patients is more complex than simply stratifying them by LVEF cut-off values because these patients have a high burden of cardiovascular and non-cardiovascular comorbidities, which may interact on different levels of LVEF, and may influence prognosis more than the LVEF category. There was a discrete predominance of patients with HFrEF at this institution, in consonance with previous Cavalcanti et al. Decompensated heart failure with intermediate ejection fraction Int J Cardiovasc Sci. 2020;33(1):45-54 Original Article