Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie?
Autor: | Wehner GJ; Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA., Jing L; Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA., Haggerty CM; Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA., Suever JD; Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA., Leader JB; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA., Hartzel DN; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA., Kirchner HL; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA., Manus JNA; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA., James N; Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand., Ayar Z; Clinical Informatics Service, Waitemata District Health Board, Auckland, New Zealand., Gladding P; Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand., Good CW; Heart Institute, Geisinger, Danville, PA, USA., Cleland JGF; Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Imperial College London, London, UK., Fornwalt BK; Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA.; Biomedical and Translational Informatics Institute, Geisinger, Danville, PA, USA.; Heart Institute, Geisinger, Danville, PA, USA.; Department of Radiology, Geisinger, 100 North Academy Avenue, Danville 17822-4400, PA, USA. |
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Jazyk: | angličtina |
Zdroj: | European heart journal [Eur Heart J] 2020 Mar 21; Vol. 41 (12), pp. 1249-1257. |
DOI: | 10.1093/eurheartj/ehz550 |
Abstrakt: | 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. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.) |
Databáze: | MEDLINE |
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