Impact of left ventricular function on clinical outcomes among patients with coronary artery disease

Abstract

Aims To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention. Methods and results Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40–49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75–3.28, p < 0.001) and 1.68 (95% confidence interval 1.34–2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons). Conclusion Patients with reduced LVEF <40% or mid-range LVEF 40–49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.

A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome

“…LVEF measurement by transthoracic echocardiography is recommended in all patients with CCS, and reassessment should be performed after an acute event [ 20 ]. This recommendation is based on the different clinical management of patients with mid-range but especially reduced-LVEF, along with the fact that LVEF is a strong predictor of outcomes in patients with CCS [ 7 ] and in a broader general population [ 21 ]. Due to its higher temporal and spatial resolution and better reproducibility, CMR constitutes the gold standard for LVEF and left ventricular volumes measurement [ 22 ].…”

“…Currently, CMR represents the gold-standard non-invasive imaging technique for an accurate quantification of key parameters in CCS patients such as left ventricular ejection fraction (LVEF) [ 7 ], late gadolinium enhancement (LGE) [ 8 , 9 ] and the presence of ischemia [ 10 , 11 , 12 ].…”

Left Atrial Dimension to Left Ventricle Ejection Fraction Ratio Can Predict Long-Term Major Adverse Events In Patients With Acute Coronary Syndrome

“…Besides, increased LAd was found to be precipitated arterial hypertension, AF, and stroke in normal population and ACS patients (4,5). Left ventricular ejection fraction (LVEF) is examined to evaluate current clinical status in patients with ACS, routinely (6). However, in case of the preserved left ventricular ejection fraction or atrial size, the outcome can be undervalued than actual it is.…”

Atrial fibrillation is associated with impaired exercise capacity and adverse prognosis in patients with heart failure with mid-range ejection fraction

“…Heart failure with mid-range ejection fraction (HFmrEF), in which left ventricular ejection fraction (LVEF) ranges from 40% to 49%, has been attracting great interest over the last decade. 1–3 Patients with HFmrEF demonstrate characteristics and prognosis that are intermediate between those with heart failure with reduced and with preserved ejection fraction (HFrEF and HFpEF, respectively), partially close to HFpEF. 4,5 In addition, factors associated with prognosis are similar, but partially different, among HFrEF, HFmrEF and HFpEF.…”