High LVEF (>65%) was associated with higher all-cause mortality in women compared to normal LVEF (8.6% vs. 7.1%, P=0.032), with a significant interaction by male sex (HR 0.63, 95% CI 0.41-0.98).
Cohort (n=4,632)
Yes
Does high LVEF (>65%) increase long-term mortality in women compared to men?
High LVEF (>65%) is associated with increased long-term all-cause mortality in women, but not in men, suggesting hyperdynamic left ventricles may carry sex-specific prognostic risk.
Absolute Event Rate: 8.6% vs 7.1%
p-value: p=0.032
AIMS: There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men. METHODS AND RESULTS: A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low 65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD). CONCLUSION: Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01443637.
Gebhard et al. (Mon,) conducted a cohort in Coronary artery disease (n=4,632). High LVEF (>65%) vs. Normal LVEF (55-65%) was evaluated on All-cause mortality in women (p=0.032). High LVEF (>65%) was associated with higher all-cause mortality in women compared to normal LVEF (8.6% vs. 7.1%, P=0.032), with a significant interaction by male sex (HR 0.63, 95% CI 0.41-0.98).