AIMS There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men. METHODS AND RESULTS A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low <55%, normal 55-65%, and high >65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD). CONCLUSION Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01443637.

中文翻译：

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左心室射血分数高的妇女的长期死亡率增加：CONFIRM（临床结果的冠状CT血管造影评估：国际多中心）长期注册数据。

目的左心室射血分数（LVEF）存在明显的性别差异，女性中LVEF较高。我们试图评估男女左室射血分数升高的临床相关性。方法和结果总计4632例来自CONFIRM（冠状动脉CT血管造影术临床结果评估：国际多中心）注册的患者（女性44.8％；男性平均年龄58.7±13.2岁，女性平均年龄59.5±13.3岁，P = 0.05） LVEF是通过心脏计算机体层摄影术测量的，根据LVEF进行分类（低<55％，正常55-65％和高> 65％）。男女高LVEF的患病率相似（女性33.5％，男性32.5％，P = 0.46）。经过6年的随访，在整个队列中LVEF高的患者的死亡率无差异（P = 0.41）。如果按性别对数据进行分层，则与正常LVEF的女性相比，LVEF高的女性死于各种原因的几率更高（8.6％vs. 7.1％，对数秩P = 0.032），而男性则相反（5.8％）正常LVEF则为6.8％，对数等级P = 0.89）。因此，在针对年龄，心血管疾病危险因素进行了调整的全因死亡率的Cox回归模型中，男性与高LVEF的一级交互作用项具有显着意义（危险比0.63，95％置信区间0.41-0.98，P = 0.043）。和冠状动脉疾病（CAD）的严重程度。结论LVEF升高在推荐用于CAD的患者中非常普遍，并且与女性死亡风险增加有关，而与男性无关。区分正常和高动力性左心室可能会改善患有CAD的女性的危险分层。