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Supranormal Left Ventricular Ejection Fraction, Stroke Volume, and Cardiovascular Risk
JACC: Heart Failure ( IF 13.0 ) Pub Date : 2022-07-25 , DOI: 10.1016/j.jchf.2022.05.007
Sonia Shah 1 , Matthew W Segar 2 , Nitin Kondamudi 1 , Colby Ayers 1 , Alvin Chandra 1 , Susan Matulevicius 1 , Kartik Agusala 1 , Ron Peshock 3 , Suhny Abbara 3 , Erin D Michos 4 , Mark H Drazner 1 , Joao A C Lima 4 , W T Longstreth 5 , Ambarish Pandey 1
Affiliation  

Background

Supranormal ejection fraction by echocardiography in clinically referred patient populations has been associated with an increased risk of cardiovascular disease (CVD). The prognostic implication of supranormal left ventricular ejection fraction (LVEF)—assessed by cardiac magnetic resonance (CMR)—in healthy, community-dwelling individuals is unknown.

Objectives

The purpose of this study is to investigate the prognostic implication of supranormal LVEF as assessed by CMR and its inter-relationship with stroke volume among community-dwelling adults without CVD.

Methods

Participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) cohorts free of CVD who underwent CMR with LVEF above the normal CMR cutoff (≥57%) were included. The association between cohort-specific LVEF categories and risk of clinically adjudicated major adverse cardiovascular events (MACE) was assessed using adjusted Cox models. Subgroup analysis was also performed to evaluate the association of LVEF and risk of MACE among individuals stratified by left ventricular stroke volume index.

Results

The study included 4,703 participants from MESA and 2,287 from DHS with 727 and 151 MACE events, respectively. In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs Q1) in both cohorts after accounting for potential confounders (MESA: HR = 1.27 [95% CI: 1.01-1.60], P = 0.04; DHS: HR = 1.72 [95% CI: 1.05-2.79], P = 0.03). A significant interaction was found between the continuous measures of LVEF and left ventricular stroke volume index (P interaction = 0.02) such that higher LVEF was significantly associated with an increased risk of MACE among individuals with low but not high stroke volume.

Conclusions

Among community-dwelling adults without CVD, LVEF in the supranormal range is associated with a higher risk of adverse cardiovascular outcomes, particularly in those with lower stroke volume.



中文翻译:

超正常左心室射血分数、每搏输出量和心血管风险

背景

在临床转诊的患者群体中,超声心动图显示的超正常射血分数与心血管疾病 (CVD) 风险增加相关。通过心脏磁共振 (CMR) 评估的超正常左心室射血分数 (LVEF) 对健康社区居民的预后意义尚不清楚。

目标

本研究的目的是调查无 CVD 的社区居住成年人中通过 CMR 评估的超正常 LVEF 的预后意义及其与每搏量的相互关系。

方法

来自 MESA(多种族动脉粥样硬化研究)和 DHS(达拉斯心脏研究)队列的无 CVD 且接受 CMR 且 LVEF 高于正常 CMR 截止值(≥57%)的参与者均被纳入其中。使用调整后的 Cox 模型评估队列特定 LVEF 类别与临床判定的主要不良心血管事件 (MACE) 风险之间的关联。还进行了亚组分析,以评估按左心室每搏输出量指数分层的个体中 LVEF 与 MACE 风险的关联。

结果

该研究包括来自 MESA 的 4,703 名参与者和来自 DHS 的 2,287 名参与者,分别发生了 727 起和 151 起 MACE 事件。在调整后的 Cox 模型中,考虑到潜在的混杂因素后,两个队列中 LVEF Q4(与 Q1)中的个体发生 MACE 的风险最高(MESA:HR = 1.27 [95% CI:1.01-1.60],P = 0.04;DHS: HR = 1.72 [95% CI: 1.05-2.79],P = 0.03)。研究发现,连续测量的 LVEF 和左心室每搏输出量指数之间存在显着的交互作用(P交互作用 = 0.02),因此在每搏输出量低但非高的个体中,较高的 LVEF 与 MACE 风险增加显着相关。

结论

在没有 CVD 的社区居民中,超正常范围的 LVEF 与不良心血管结局的风险较高相关,特别是对于每搏输出量较低的患者。

更新日期:2022-07-25
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