Zhang Zhongying, Fang Xianghua, Liu Cuicui, Wang Chunxiu, Liu Hongjun, Lu Wenbin, Guan Shaochen, Li Huihui, Liu Chunxiao, Fan Shuai, Yang Ya
Geriatric Department Xuanwu Hospital, Capital Medical University Beijing China.
Evidence-Based Medical Center Xuanwu Hospital, Capital Medical University Beijing China.
J Am Heart Assoc. 2025 Jun 17;14(12):e038777. doi: 10.1161/JAHA.124.038777. Epub 2025 Jun 5.
Although previous studies have suggested that left ventricular ejection fraction (LVEF) adjusted by left ventricular mass (LVM) might improve prognostic risk stratification of cardiac events, few prospective cohort studies have examined its clinical implications. We assessed the predictive ability of LVEF indexed to LVM, body surface area (BSA), and body mass index for the cardiac event risk.
We conducted a 5.52-year cohort study on the association between LVEF indexed to LVM and cardiac events among 4266 participants with mildly reduced or preserved LVEF. Multivariable Cox regression analysis incorporating restricted cubic spline functions evaluated the predictive ability of LVEF, LVEF/LVM, and other indexed measures.
After multivariable Cox regression adjustment, LVEF/LVM, LVEF/LVM/BSA, and LVEF/LVM/body mass index remained significantly associated with cardiac events (all <0.05), whereas LVEF alone was not (=0.569). Restricted cubic spline analysis identified a nonlinear approximately U-shaped relationship for both LVEF/LVM and LVEF/LVM/BSA (both for nonlinearity<0.001). Compared with the middle reference group, participants in the low LVEF/LVM (hazard ratio [HR], 2.00 [95% CI, 1.08-3.71]) and low LVEF/LVM/BSA (HR, 2.13 [95% CI, 1.11-4.07]) groups had significantly higher risks. While the high groups showed nonsignificant differences (LVEF/LVM: HR, 1.41 [95% CI, 0.68-2.95]; LVEF/LVM/BSA: HR, 1.39 [95% CI, 0.65-2.99]), the observed risk pattern indicated that values outside the ranges of 4.72 to 5.53/kg (LVEF/LVM) and 19.7 to 24.3 m/kg (LVEF/LVM/BSA) suggested a higher cardiac event risk.
LVEF indexed to LVM provides better cardiac event risk stratification than LVEF alone in individuals with mildly reduced or preserved ejection fraction.
尽管先前的研究表明，通过左心室质量（LVM）调整的左心室射血分数（LVEF）可能会改善心脏事件的预后风险分层，但很少有前瞻性队列研究探讨其临床意义。我们评估了LVM、体表面积（BSA）和体重指数校正后的LVEF对心脏事件风险的预测能力。
我们对4266名LVEF轻度降低或保留的参与者进行了一项为期5.52年的队列研究，探讨LVM校正后的LVEF与心脏事件之间的关联。采用包含受限立方样条函数的多变量Cox回归分析评估LVEF、LVEF/LVM及其他校正指标的预测能力。
经过多变量Cox回归调整后，LVEF/LVM、LVEF/LVM/BSA和LVEF/LVM/体重指数仍与心脏事件显著相关（均P<0.05），而单独的LVEF则不然（P=0.569）。受限立方样条分析确定LVEF/LVM和LVEF/LVM/BSA均呈非线性近似U形关系（两者非线性P<0.001）。与中间参考组相比，低LVEF/LVM组（风险比[HR]，2.00[95%CI，1.08-3.71]）和低LVEF/LVM/BSA组（HR，2.13[95%CI，1.11-4.07]）的参与者风险显著更高。虽然高分组显示差异不显著（LVEF/LVM：HR，1.41[95%CI，0.68-2.95]；LVEF/LVM/BSA：HR，1.39[95%CI，0.65-2.99]），但观察到的风险模式表明，4.72至5.53/kg（LVEF/LVM）和19.7至24.3 m/kg（LVEF/LVM/BSA）范围之外的值提示心脏事件风险更高。
对于射血分数轻度降低或保留的个体，LVM校正后的LVEF比单独的LVEF能提供更好的心脏事件风险分层。
