Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.
JACC Heart Fail. 2022 Aug;10(8):583-594. doi: 10.1016/j.jchf.2022.05.007.
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.
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.
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.
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.
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.
超声心动图检查发现临床转诊患者群体的射血分数高于正常范围与心血管疾病（CVD）风险增加有关。通过心脏磁共振（CMR）评估的左心室射血分数（LVEF）高于正常范围的健康社区居民的预后意义尚不清楚。
本研究旨在探讨通过 CMR 评估的超正常 LVEF 与 CVD 社区居民的每搏量之间的预后相关性。
本研究纳入了 MESA（动脉粥样硬化多民族研究）和 DHS（达拉斯心脏研究）队列中没有 CVD 的 CMR 检查 LVEF 高于正常 CMR 截断值（≥57%）的参与者。使用调整后的 Cox 模型评估队列特异性 LVEF 分类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 LVEF 与按左心室每搏量指数分层的个体中 MACE 风险的关联。
本研究纳入了来自 MESA 的 4703 名参与者和 DHS 的 2287 名参与者，分别有 727 名和 151 名 MACE 事件。在调整后的 Cox 模型中，在考虑到潜在混杂因素后，两个队列中 LVEF Q4（与 Q1 相比）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）。LVEF 和左心室每搏量指数的连续测量之间存在显著的交互作用（P 交互=0.02），即较高的 LVEF 与低但不是高每搏量的个体发生 MACE 的风险增加显著相关。
在没有 CVD 的社区居民中，射血分数高于正常范围与不良心血管结局风险增加相关，特别是在每搏量较低的患者中。
