Small Heart Size and Premature Death in 366,484 Individuals With Normal Ejection Fraction

Figures

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  Figure 1. Study Flowchart Study flowchart displaying the subjects meeting inclusion criteria for this study. There were 366,484 individuals with a measured LVEF ≥50% and 279,442 individuals with LVEF ≥60% for further subanalysis. LVEF = left ventricular ejection fraction.

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  Figure 2. Distribution of Age at Echo for Increasing Quartiles of Left Ventricular End-Diastolic Volume in Individuals With Left Ventricular Ejection Fraction ≥50% Violin plots demonstrating median (white dot), IQR (blue boxes), and kernel density estimation showing distribution shape. LVEDV = left ventricular end-diastolic volume; Q = quartile.

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  Figure 3. The “Small Heart: 5-Year All-Cause Mortality for Smallest Cardiac Size Compared to Reference “Normal” for Males and Females Plots show the adjusted OR (±95% CI) for all-cause mortality for the smallest quartile of cardiac size relative to the reference group (remaining quartiles) for individuals with LVEF ≥50% (blue circle) and LVEF ≥60% (orange circle). The box inserts show the adjusted ORs (±95% CI). Adj OR = OR adjusted for age and BSA unless already indexed to BSA. The significance for each OR is denoted by ∗∗P < 0.0001. LVEDD = left ventricular end-diastolic diameter; LVEDVi = LVEDV indexed to BSA; other abbreviation as in Figure 2.

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  Figure 4. 5-Year Adjusted All-Cause Mortality by Sex and Quartiles of Cardiac Chamber Measures The box inserts show the adjusted odds ratios (± 95% CI). Plots show the adjusted odds ratio (±95% CI) for all-cause mortality for increasing quartiles of cardiac size relative to the smallest quartile for individuals with LVEF ≥50% (blue circle) and LVEF ≥60% (orange circle). Q = quartile; Adj OR = OR adjusted for age and BSA unless already indexed to BSA. ∗P < 0.05 and ∗∗P < 0.0001. Abbreviations as in Figures 2 and 3.

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  Figure 5. Long-Term All-Cause Mortality by Left Ventricular End-Diastolic Volume Quartiles The Kaplan-Meier curve shows long-term all-cause mortality for individuals with LVEF ≥50%. Box insert shows HRs and 95% CIs adjusted for age and sex for quartiles of cardiac size relative to the smallest quartile (quartile 1).

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  Central Illustration. Small Cardiac Size Is Associated With Increased Mortality in Individuals With Normal Ejection Fraction This figure was Created using biorender.com. BSA = body surface area; OR = odds ratio adjusted for age; other abbreviations as in Figure 1, Figure 2, Figure 3.