Krittayaphong Rungroj, Songsangjinda Thammarak, Jirataiporn Kanchalaporn, Yindeengam Ahthit
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand.
Cardiology Unit, Division of Internal Medicine, Faculty of Medicine Prince of Songkla University Songkhla Thailand.
J Am Heart Assoc. 2025 Apr 15;14(8):e039889. doi: 10.1161/JAHA.124.039889. Epub 2025 Apr 3.
Contradictory evidence exists regarding the correlation between supranormal left ventricular ejection fraction (LVEF) and adverse outcomes. This study aimed to elucidate the prognostic value of supranormal LVEF.
This retrospective cohort study analyzed patients referred for cardiac magnetic resonance imaging to assess myocardial ischemia or viability. Subjects were stratified into eig8ht LVEF groups: <20%, 20% to 30%, 30% to 40%, 40% to 50%, 50% to 60%, 60% to 70%, 70% to 80%, and ≥80%. Primary outcomes included cardiovascular death, heart failure, myocardial infarction, and stroke. The extracellular volume fraction was measured.
The study cohort comprised 3279 patients (mean age 68.0±12.7 years; 64.0% female). The group with 60% to 70% LVEF had the lowest risk and was used as the reference group. The median follow-up was 41.4 months (interquartile range, 33.9-49.7 months). The group with LVEF <20% exhibited the highest composite outcome risk (unadjusted hazard ratio [HR], 6.77 [95% CI, 3.81-12.03]; <0.001; adjusted HR, 2.68 [95% CI, 1.28-5.62]; <0.001). The groups with LVEF 70% to 80% and ≥80% showed increased risk (adjusted HR, 1.96 [95% CI, 1.23-3.08]; =0.004; 2.16 [95% CI, 1.33-3.52]; =0.002, respectively). A greater extracellular volume fraction was associated with an LVEF of 70% to 80% and ≥80% (adjusted odds ratios, 1.34 [95% CI, 1.03-1.74]; =0.027; and 1.74 [95% CI, 1.30-2.34]; <0.001, respectively).
LVEF >70% demonstrated increased event rates compared with an LVEF of 60% to 70%. The supranormal LVEF warrants further investigation into its pathogenesis and management.
关于左心室射血分数（LVEF）超常与不良预后之间的相关性存在相互矛盾的证据。本研究旨在阐明LVEF超常的预后价值。
这项回顾性队列研究分析了因心脏磁共振成像以评估心肌缺血或存活情况而转诊的患者。受试者被分为八个LVEF组：<20%、20%至30%、30%至40%、40%至50%、50%至60%、60%至70%、70%至80%和≥80%。主要结局包括心血管死亡、心力衰竭、心肌梗死和中风。测量细胞外容积分数。
研究队列包括3279例患者（平均年龄68.0±12.7岁；64.0%为女性）。LVEF为60%至70%的组风险最低，被用作参照组。中位随访时间为41.4个月（四分位间距，33.9 - 49.7个月）。LVEF<20%的组复合结局风险最高（未调整风险比[HR]，6.77[95%CI，3.81 - 12.03]；<0.001；调整后HR，2.68[95%CI，1.28 - 5.62]；<0.001）。LVEF为70%至80%和≥80%的组显示风险增加（调整后HR分别为1.96[95%CI，1.23 - 3.08]；=0.004；2.16[95%CI，1.33 - 3.52]；=0.002）。较高的细胞外容积分数与LVEF为70%至80%和≥80%相关（调整后比值比分别为1.34[95%CI，1.03 - 1.74]；=0.027；和1.74[95%CI，1.30 - 2.34]；<0.001）。
与LVEF为60%至70%相比，LVEF>70%显示事件发生率增加。LVEF超常值得进一步研究其发病机制和管理。
