AIMS We investigated the relationship between clinically assessed left ventricular ejection fraction (LVEF) and survival in a large, heterogeneous clinical cohort. METHODS AND RESULTS Physician-reported LVEF on 403 977 echocardiograms from 203 135 patients were linked to all-cause mortality using electronic health records (1998-2018) from US regional healthcare system. Cox proportional hazards regression was used for analyses while adjusting for many patient characteristics including age, sex, and relevant comorbidities. A dataset including 45 531 echocardiograms and 35 976 patients from New Zealand was used to provide independent validation of analyses. During follow-up of the US cohort, 46 258 (23%) patients who had undergone 108 578 (27%) echocardiograms died. Overall, adjusted hazard ratios (HR) for mortality showed a u-shaped relationship for LVEF with a nadir of risk at an LVEF of 60-65%, a HR of 1.71 [95% confidence interval (CI) 1.64-1.77] when ≥70% and a HR of 1.73 (95% CI 1.66-1.80) at LVEF of 35-40%. Similar relationships with a nadir at 60-65% were observed in the validation dataset as well as for each age group and both sexes. The results were similar after further adjustments for conditions associated with an elevated LVEF, including mitral regurgitation, increased wall thickness, and anaemia and when restricted to patients reported to have heart failure at the time of the echocardiogram. CONCLUSION Deviation of LVEF from 60% to 65% is associated with poorer survival regardless of age, sex, or other relevant comorbidities such as heart failure. These results may herald the recognition of a new phenotype characterized by supra-normal LVEF.

中文翻译：

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临床实践中常规报告的射血分数和死亡率：风险的最低点在哪里？


目的 我们在一个大型、异质的临床队列中研究了临床评估的左心室射血分数 (LVEF) 与生存率之间的关系。方法和结果使用美国地区医疗保健系统的电子健康记录（1998-2018），将医生报告的 203 135 名患者的 403 977 幅超声心动图的 LVEF 与全因死亡率联系起来。使用 Cox 比例风险回归进行分析，同时调整许多患者特征，包括年龄、性别和相关合并症。使用包含 45 531 幅超声心动图和来自新西兰的 35 976 名患者的数据集来提供独立的分析验证。在美国队列的随访期间，接受了 108 578 次（27%）超声心动图检查的 46 258 名患者（23%）死亡。总体而言，调整后的死亡率风险比 (HR) 与 LVEF 呈 U 形关系，当 ≥ 时，LVEF 为 60-65%，风险最低点为 1.71 [95% 置信区间 (CI) 1.64-1.77]。 LVEF 为 35-40% 时，HR 为 70%，HR 为 1.73 (95% CI 1.66-1.80)。在验证数据集中以及每个年龄组和两个性别中都观察到与最低点 60-65% 的类似关系。对与 LVEF 升高相关的情况（包括二尖瓣反流、壁厚增加和贫血）进行进一步调整后，以及仅限于在超声心动图检查时报告患有心力衰竭的患者时，结果相似。结论 无论年龄、性别或其他相关合并症（如心力衰竭），LVEF 偏离 60% 至 65% 均与较差的生存率相关。这些结果可能预示着对一种以超正常 LVEF 为特征的新表型的认识。