Gentile P, Merlo M, Cannatà A, et al. - From the Trieste Heart Muscle Disease Registry, a total of 175 dilated cardiomyopathy patients with mid-range ejection fraction (mrEF) at diagnosis were investigated for their characteristics, evolution, and long-term prognosis. Baseline left ventricular (LV) ejection fraction values between 40% and 49% and < 40% defined mrEF and reduced ejection fraction (rEF), respectively. A median follow-up period of 120 (60–204) months revealed a lower rate of death/heart transplantation and sudden cardiac death or major ventricular arrhythmias in the mrEF group vs rEF patients. Researchers concluded that mrEF identified a consistent subgroup diagnosed in an earlier stage with subsequent apparent better long-term evolution. However, even the use of medical therapy could not prevent 17% of these patients from evolving into rEF. An independent link of a baseline restrictive LV filling pattern with subsequent evolution to rEF was found.