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Increased long-term mortality in women with high left ventricular ejection fraction: data from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) long-term registry.


ABSTRACT:

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.

SUBMITTER: Gebhard C 

PROVIDER: S-EPMC7778362 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Publications

Increased long-term mortality in women with high left ventricular ejection fraction: data from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) long-term registry.

Gebhard Catherine C   Maredziak Monika M   Messerli Michael M   Buechel Ronny R RR   Lin Fay F   Gransar Heidi H   Achenbach Stephan S   Al-Mallah Mouaz H MH   Andreini Daniele D   Bax Jeroen J JJ   Berman Daniel S DS   Budoff Matthew J MJ   Cademartiri Filippo F   Callister Tracy Q TQ   Chang Hyuk-Jae HJ   Chinnaiyan Kavitha K   Chow Benjamin J W BJW   Cury Ricardo C RC   DeLago Augustin A   Feuchtner Gudrun G   Hadamitzky Martin M   Hausleiter Joerg J   Kim Yong-Jin YJ   Leipsic Jonathon J   Maffei Erica E   Marques Hugo H   Gonçalves Pedro de Araújo PA   Pontone Gianluca G   Raff Gilbert L GL   Rubinshtein Ronen R   Shaw Leslee J LJ   Villines Todd C TC   Lu Yao Y   Jones Erica C EC   Peña Jessica M JM   Min James K JK   Kaufmann Philipp A PA  

European heart journal. Cardiovascular Imaging 20200401 4


<h4>Aims</h4>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.<h4>Methods and results</h4>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 LV  ...[more]

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