Key result
High LVEF links to lower mortality and MI versus lower LVEF among women with suspected ischaemia.
Why the study?
Women have a relatively higher LVEF than men, but a sex-neutral LVEF threshold continues to be used for clinical management.
Does LVEF category predict long-term all-cause mortality and MACE in women presenting with suspected myocardial ischaemia?
Cohort (n=734)
Does LVEF category predict long-term all-cause mortality and MACE in women presenting with suspected myocardial ischaemia?
p-value: p=<0.0001
In women with suspected ischemia, an LVEF >65% is associated with lower rates of all-cause mortality and non-fatal MI compared to normal (55-65%) or low (<55%) LVEF, suggesting sex-specific LVEF thresholds may be needed.
Should not yet change LVEF thresholds in women with suspected ischemia; hypothesis-generating for sex-specific cutoffs needing prospective validation.
BACKGROUND: Although women are known to have a relatively higher left ventricular ejection fraction (LVEF) compared with men, a sex-neutral LVEF threshold continues to be used for clinical management. We sought to investigate the relationship among high (>65%), normal (55%-65%) and low (<55%) LVEF and long-term all-cause mortality and major adverse cardiovascular events (MACEs) in women presenting with suspected myocardial ischaemia. METHODS: A total of 734 women from the Women's Ischemia Syndrome Evaluation (WISE) were analysed. LVEF was calculated by invasive left ventriculography. The relationship between baseline characteristics, LVEF and outcomes was evaluated. A multivariable Cox regression model was used to assess the association of LVEF with outcomes, after adjusting for known risk factors. RESULTS: Low LVEF was associated with higher rates of mortality and MACE compared with normal and high LVEF (p<0.0001). Normal LVEF was associated with higher mortality (p=0.047) and rate of myocardial infarctions (MIs) compared with high LVEF (p=0.03). Low LVEF remained a significant predictor of mortality compared with high LVEF (p=0.013) in a multivariable regression model and normal compared with high LVEF trended towards higher mortality (p=0.16). CONCLUSION: Among women with suspected ischaemia, women with LVEF above the defined normal threshold (>65%) had lower rates of all-cause mortality and non-fatal MI. Further investigation is needed to determine the optimal LVEF in women. TRIAL REGISTRATION NUMBER: NCT00000554.
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Wu et al. (2023) conducted a cohort in suspected myocardial ischaemia (n=734). High LVEF (>65%) vs. Normal (55%-65%) and low (<55%) LVEF was evaluated on long-term all-cause mortality and major adverse cardiovascular events (MACEs) (p=<0.0001). Among women with suspected ischaemia, high LVEF (>65%) was associated with lower rates of all-cause mortality and non-fatal MI compared to normal (55-65%) or low (<55%) LVEF.
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