Etiological Spectrum of Heart Failure with Reduced Ejection Fraction in a Moroccan Military Hospital: A Comparative Registry Analysis

Abstract

Background: The etiological distribution of heart failure with reduced ejection fraction (HFrEF) varies significantly across regions, reflecting differences in cardiovascular risk factor prevalence, genetic predisposition, and healthcare access. Data from North African military populations are scarce. This study aimed to characterize the etiological spectrum of HFrEF in a Moroccan military hospital and compare findings with major international registries. Methods: This was a retrospective observational registry study conducted at the Avicenne Military Hospital, Marrakech, Morocco, over a two-year period (2021–2023). Etiologies were systematically classified in 173 consecutive HFrEF patients (left ventricular ejection fraction <40%) based on clinical history, electrocardiographic findings, echocardiographic pattern, and coronary angiographic results. Descriptive statistics were used, with results expressed as frequencies and percentages for categorical variables and means ± standard deviations for continuous variables. Results: A total of 173 patients were included (mean age 67.9 ± 8.7 years; 80% male). The dominant cardiovascular risk factors were sedentary lifestyle (85%), smoking (53%), diabetes mellitus (45%), hypertension (33%), and dyslipidemia (33%). Ischemic cardiomyopathy was the predominant etiology (56.6%), followed by idiopathic dilated cardiomyopathy (17.3%), hypertensive cardiomyopathy (11.6%), arrhythmia-induced cardiomyopathy (6.4%), valvular cardiomyopathy (5.8%), and toxic cardiomyopathy (1.7%). Coronary angiography was performed in 118 patients (68.2%), with multivessel disease as the most frequent finding: tritroncoronary involvement in 22%, bitroncoronary in 14%, and single-vessel significant disease in 19%. The left anterior descending artery was the most commonly affected vessel (41%). Compared to international registries, the ischemic etiology burden exceeded that of the Asian JCARE-CARD registry (34.0%) and the African INTER-CHF cohort (13.0%), and aligned with the ESC HF Long-Term Registry (48.6%) and the SwedeHF registry (60.0%). Conclusion: Ischemic cardiomyopathy dominates the etiological spectrum of HFrEF in this Moroccan military cohort, reinforcing the priority of coronary risk factor management and timely coronary revascularization in prevention strategies. Future multicenter prospective studies across North Africa and expanded access to cardiac MRI are recommended.