Prognosis of Low Normal Left Ventricular Ejection Fraction in an Asymptomatic Population-Based Adult Cohort: The Multiethnic Study of Atherosclerosis

Joseph Yeboah, Carlos J. Rodriguez, Waqas Qureshi, Songtao Liu, J. Jeffrey Carr, Joao A. Lima, W. Gregory Hundley, David M. Herrington

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Reduced left ventricular systolic function predicts worse outcomes. However, the optimal threshold for “normal” left ventricular ejection fraction (LVEF) is uncertain. In general, LVEF ≥ 55% is considered to be “normal” by guidelines, with a low normal designation for LVEF being 50%–55%. We assessed the prognosis of participants with low normal LVEF in the Multiethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical cardiovascular disease at baseline. Methods and Results A total of 4926 out of 6814 had LVEF assessed with the use of cardiac magnetic resonance imaging (MRI), had no significant valvular disease, did not have myocardial infarction during follow-up, had complete data, and were included in this analysis. A total of 83/4926 (1.7%) had LVEF < 50% (low LVEF) and 101/4926 (2.1%) had low normal LVEF. Cox proportional hazard and cubic spline analyses were used to evaluate the association between LVEF category and 10 years of adjudicated incident congestive heart failure (CHF) and all-cause mortality adjusting for (model 1) age, sex, and race and (model 2) model 1 and diabetes mellitus, smoking, systolic blood pressure (BP), BP medications, body mass index, estimated glomerular filtration rate, low-density lipoprotein, family history of coronary heart disease, educational status, and LV mass. Mean age was 61 ± 10 years, 47% were men, 35% were on BP medications, 9% had diabetes. After 10.2 years of follow-up, 109 (2.2%) had CHF and 427 (8.7%) died. Compared with normal LVEF (≥55%), low normal LVEF and low LVEF were associated with an increased risk for incident CHF during follow-up in our multivariable Cox models: hazard ratios (HRs) 3.64 (95% CI 1.76–7.52) and 9.52 (5.63–17.52), respectively. Unlike low LVEF, low normal LVEF was not associated with increased risk of death compared with normal LVEF in our fully adjusted models: HRs 3.03 (1.94–4.73) and 1.32 (0.72–2.41), respectively. In the adjusted spline analysis HR of LVEF 55% as reference, LVEF had a U-shape association of future CHF risk and LVEF. Conclusion Low normal LVEF is as prevalent as low LVEF in asymptomatic community-dwelling adults. We observed a gradient-response association between the 3 categories of LVEF (low, low normal, and normal) and incident CHF but not for all-cause death.

Original languageEnglish (US)
Pages (from-to)763-768
Number of pages6
JournalJournal of Cardiac Failure
Volume22
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

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Stroke Volume
Atherosclerosis
Population
Heart Failure
Blood Pressure
Proportional Hazards Models
Independent Living
Educational Status
Glomerular Filtration Rate
LDL Lipoproteins
Left Ventricular Function

Keywords

  • congestive heart failure
  • death
  • Low normal left ventricular ejection fraction
  • prevalence
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognosis of Low Normal Left Ventricular Ejection Fraction in an Asymptomatic Population-Based Adult Cohort : The Multiethnic Study of Atherosclerosis. / Yeboah, Joseph; Rodriguez, Carlos J.; Qureshi, Waqas; Liu, Songtao; Carr, J. Jeffrey; Lima, Joao A.; Hundley, W. Gregory; Herrington, David M.

In: Journal of Cardiac Failure, Vol. 22, No. 10, 01.10.2016, p. 763-768.

Research output: Contribution to journalArticle

Yeboah, Joseph ; Rodriguez, Carlos J. ; Qureshi, Waqas ; Liu, Songtao ; Carr, J. Jeffrey ; Lima, Joao A. ; Hundley, W. Gregory ; Herrington, David M. / Prognosis of Low Normal Left Ventricular Ejection Fraction in an Asymptomatic Population-Based Adult Cohort : The Multiethnic Study of Atherosclerosis. In: Journal of Cardiac Failure. 2016 ; Vol. 22, No. 10. pp. 763-768.
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abstract = "Background Reduced left ventricular systolic function predicts worse outcomes. However, the optimal threshold for “normal” left ventricular ejection fraction (LVEF) is uncertain. In general, LVEF ≥ 55{\%} is considered to be “normal” by guidelines, with a low normal designation for LVEF being 50{\%}–55{\%}. We assessed the prognosis of participants with low normal LVEF in the Multiethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical cardiovascular disease at baseline. Methods and Results A total of 4926 out of 6814 had LVEF assessed with the use of cardiac magnetic resonance imaging (MRI), had no significant valvular disease, did not have myocardial infarction during follow-up, had complete data, and were included in this analysis. A total of 83/4926 (1.7{\%}) had LVEF < 50{\%} (low LVEF) and 101/4926 (2.1{\%}) had low normal LVEF. Cox proportional hazard and cubic spline analyses were used to evaluate the association between LVEF category and 10 years of adjudicated incident congestive heart failure (CHF) and all-cause mortality adjusting for (model 1) age, sex, and race and (model 2) model 1 and diabetes mellitus, smoking, systolic blood pressure (BP), BP medications, body mass index, estimated glomerular filtration rate, low-density lipoprotein, family history of coronary heart disease, educational status, and LV mass. Mean age was 61 ± 10 years, 47{\%} were men, 35{\%} were on BP medications, 9{\%} had diabetes. After 10.2 years of follow-up, 109 (2.2{\%}) had CHF and 427 (8.7{\%}) died. Compared with normal LVEF (≥55{\%}), low normal LVEF and low LVEF were associated with an increased risk for incident CHF during follow-up in our multivariable Cox models: hazard ratios (HRs) 3.64 (95{\%} CI 1.76–7.52) and 9.52 (5.63–17.52), respectively. Unlike low LVEF, low normal LVEF was not associated with increased risk of death compared with normal LVEF in our fully adjusted models: HRs 3.03 (1.94–4.73) and 1.32 (0.72–2.41), respectively. In the adjusted spline analysis HR of LVEF 55{\%} as reference, LVEF had a U-shape association of future CHF risk and LVEF. Conclusion Low normal LVEF is as prevalent as low LVEF in asymptomatic community-dwelling adults. We observed a gradient-response association between the 3 categories of LVEF (low, low normal, and normal) and incident CHF but not for all-cause death.",
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author = "Joseph Yeboah and Rodriguez, {Carlos J.} and Waqas Qureshi and Songtao Liu and Carr, {J. Jeffrey} and Lima, {Joao A.} and Hundley, {W. Gregory} and Herrington, {David M.}",
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T1 - Prognosis of Low Normal Left Ventricular Ejection Fraction in an Asymptomatic Population-Based Adult Cohort

T2 - The Multiethnic Study of Atherosclerosis

AU - Yeboah, Joseph

AU - Rodriguez, Carlos J.

AU - Qureshi, Waqas

AU - Liu, Songtao

AU - Carr, J. Jeffrey

AU - Lima, Joao A.

AU - Hundley, W. Gregory

AU - Herrington, David M.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background Reduced left ventricular systolic function predicts worse outcomes. However, the optimal threshold for “normal” left ventricular ejection fraction (LVEF) is uncertain. In general, LVEF ≥ 55% is considered to be “normal” by guidelines, with a low normal designation for LVEF being 50%–55%. We assessed the prognosis of participants with low normal LVEF in the Multiethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical cardiovascular disease at baseline. Methods and Results A total of 4926 out of 6814 had LVEF assessed with the use of cardiac magnetic resonance imaging (MRI), had no significant valvular disease, did not have myocardial infarction during follow-up, had complete data, and were included in this analysis. A total of 83/4926 (1.7%) had LVEF < 50% (low LVEF) and 101/4926 (2.1%) had low normal LVEF. Cox proportional hazard and cubic spline analyses were used to evaluate the association between LVEF category and 10 years of adjudicated incident congestive heart failure (CHF) and all-cause mortality adjusting for (model 1) age, sex, and race and (model 2) model 1 and diabetes mellitus, smoking, systolic blood pressure (BP), BP medications, body mass index, estimated glomerular filtration rate, low-density lipoprotein, family history of coronary heart disease, educational status, and LV mass. Mean age was 61 ± 10 years, 47% were men, 35% were on BP medications, 9% had diabetes. After 10.2 years of follow-up, 109 (2.2%) had CHF and 427 (8.7%) died. Compared with normal LVEF (≥55%), low normal LVEF and low LVEF were associated with an increased risk for incident CHF during follow-up in our multivariable Cox models: hazard ratios (HRs) 3.64 (95% CI 1.76–7.52) and 9.52 (5.63–17.52), respectively. Unlike low LVEF, low normal LVEF was not associated with increased risk of death compared with normal LVEF in our fully adjusted models: HRs 3.03 (1.94–4.73) and 1.32 (0.72–2.41), respectively. In the adjusted spline analysis HR of LVEF 55% as reference, LVEF had a U-shape association of future CHF risk and LVEF. Conclusion Low normal LVEF is as prevalent as low LVEF in asymptomatic community-dwelling adults. We observed a gradient-response association between the 3 categories of LVEF (low, low normal, and normal) and incident CHF but not for all-cause death.

AB - Background Reduced left ventricular systolic function predicts worse outcomes. However, the optimal threshold for “normal” left ventricular ejection fraction (LVEF) is uncertain. In general, LVEF ≥ 55% is considered to be “normal” by guidelines, with a low normal designation for LVEF being 50%–55%. We assessed the prognosis of participants with low normal LVEF in the Multiethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical cardiovascular disease at baseline. Methods and Results A total of 4926 out of 6814 had LVEF assessed with the use of cardiac magnetic resonance imaging (MRI), had no significant valvular disease, did not have myocardial infarction during follow-up, had complete data, and were included in this analysis. A total of 83/4926 (1.7%) had LVEF < 50% (low LVEF) and 101/4926 (2.1%) had low normal LVEF. Cox proportional hazard and cubic spline analyses were used to evaluate the association between LVEF category and 10 years of adjudicated incident congestive heart failure (CHF) and all-cause mortality adjusting for (model 1) age, sex, and race and (model 2) model 1 and diabetes mellitus, smoking, systolic blood pressure (BP), BP medications, body mass index, estimated glomerular filtration rate, low-density lipoprotein, family history of coronary heart disease, educational status, and LV mass. Mean age was 61 ± 10 years, 47% were men, 35% were on BP medications, 9% had diabetes. After 10.2 years of follow-up, 109 (2.2%) had CHF and 427 (8.7%) died. Compared with normal LVEF (≥55%), low normal LVEF and low LVEF were associated with an increased risk for incident CHF during follow-up in our multivariable Cox models: hazard ratios (HRs) 3.64 (95% CI 1.76–7.52) and 9.52 (5.63–17.52), respectively. Unlike low LVEF, low normal LVEF was not associated with increased risk of death compared with normal LVEF in our fully adjusted models: HRs 3.03 (1.94–4.73) and 1.32 (0.72–2.41), respectively. In the adjusted spline analysis HR of LVEF 55% as reference, LVEF had a U-shape association of future CHF risk and LVEF. Conclusion Low normal LVEF is as prevalent as low LVEF in asymptomatic community-dwelling adults. We observed a gradient-response association between the 3 categories of LVEF (low, low normal, and normal) and incident CHF but not for all-cause death.

KW - congestive heart failure

KW - death

KW - Low normal left ventricular ejection fraction

KW - prevalence

KW - prognosis

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