Key result
Supra-normal left ventricular ejection fraction (≥65%) was independently associated with a significantly increased risk of impaired corrected coronary flow reserve compared to normal ejection fraction (OR 4.20).
Why the study?
To explore whether a U curve exists between resting LVEF and coronary flow reserve in patients without severe CVD, and whether impaired CFR plays a role in adverse outcomes with supra-normal LVEF.
Does supra-normal resting LVEF correlate with impaired coronary flow reserve and increased MACE in patients without severe cardiovascular disease?
Observational (n=210)
No
Does supra-normal resting LVEF correlate with impaired coronary flow reserve and increased MACE in patients without severe cardiovascular disease?
Supra-normal resting LVEF (≥ 65%) is associated with impaired coronary flow reserve and an increased risk of major adverse cardiac events compared to normal LVEF.
snLVEF may link to impaired CFR without severe CVD; leaves open whether CFR mediates prognosis.
PURPOSE: Recently, a "U" hazard ratio curve between resting left ventricular ejection fraction (LVEF) and prognosis has been observed in patients referred for routine clinical echocardiograms. The present study sought to explore whether a similar "U" curve existed between resting LVEF and coronary flow reserve (CFR) in patients without severe cardiovascular disease (CVD) and whether impaired CFR played a role in the adverse outcome of patients with supra-normal LVEF (snLVEF, LVEF ≥ 65%). METHODS: N-ammonia positron emission tomography/computed tomography (PET/CT). Major adverse cardiac events (MACE) were followed up for 27.3 ± 9.5 months, including heart failure, late revascularization, re-hospitalization, and re-coronary angiography for any cardiac reason. Clinical characteristics, corrected CFR (cCFR), and MACE were compared among the three groups categorized by resting LVEF detected by PET/CT. Dose-response analyses using restricted cubic spline (RCS) functions, multivariate logistic regression, and Kaplan-Meier survival analysis were conducted to evaluate the relationship between resting LVEF and CFR/outcome. RESULTS: An inverted "U" curve existed between resting LVEF and cCFR (p = 0.06). Both patients with snLVEF (n = 38) and with reduced LVEF (rLVEF, LVEF < 55%) (n = 66) displayed a higher incidence of reduced cCFR than those with normal LVEF (nLVEF, 55% ≤ LVEF < 65%) (n = 106) (57.9% vs 54.5% vs 34.3%, p < 0.01, respectively). Both snLVEF (p < 0.01) and rLVEF (p < 0.05) remained independent predictors for reduced cCFR after multivariable adjustment. Patients with snLVEF encountered more MACE than those with nLVEF (10.5% vs 0.9%, log-rank p = 0.01). CONCLUSIONS: Patients with snLVEF are prone to impaired cCFR, which may be related to the adverse prognosis. Further investigations are warranted to explore its underlying pathological mechanism and clinical significance.
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Wu et al. (2022) conducted an observational in Patients without severe cardiovascular disease referred for myocardial injury assessment (n=210). Supra-normal left ventricular ejection fraction (LVEF ≥ 65%) vs. Normal LVEF (55% ≤ LVEF < 65%) was evaluated on Reduced corrected coronary flow reserve (cCFR < 2.5) (OR 4.20, 95% CI 1.53-11.54, p=0.005). Supra-normal left ventricular ejection fraction (≥65%) was independently associated with a significantly increased risk of impaired corrected coronary flow reserve compared to normal ejection fraction (OR 4.20).
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