Increased long-term mortality in women with high left ventricular ejection fraction: Data from the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) long-term registry


Catherine Gebhard, UniversitatsSpital Zurich
Monika Maredziak, UniversitatsSpital Zurich
Michael Messerli, UniversitatsSpital Zurich
Ronny R. Buechel, UniversitatsSpital Zurich
Fay Lin, New York Presbyterian Hospital
Heidi Gransar, Cedars-Sinai Medical Center
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Mouaz H. Al-Mallah, King Saud bin Abdulaziz University for Health Sciences
Daniele Andreini, IRCCS Centro Cardiologico Monzino
Jeroen J. Bax, Leiden University Medical Center - LUMC
Daniel S. Berman, Cedars-Sinai Medical Center
Matthew J. Budoff, The Lundquist Institute
Filippo Cademartiri, IRCCS Fondazione SDN
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Hyuk Jae Chang, Severance Hospital
Kavitha Chinnaiyan, William Beaumont Hospital
Benjamin J.W. Chow, University of Ottawa, Canada
Ricardo C. Cury, Baptist Cardiac and Vascular Institute
Augustin Delago, Capitol Cardiology Associates
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Yong Jin Kim, Seoul National University Hospital
Jonathon Leipsic, The University of British Columbia
Erica Maffei
Hugo Marques, Hospital da Luz
Pedro De Araújo Gonçalves, Hospital da Luz
Gianluca Pontone, IRCCS Centro Cardiologico Monzino
Gilbert L. Raff, William Beaumont Hospital
Ronen Rubinshtein, Technion - Israel Institute of Technology
Leslee J. Shaw, New York Presbyterian Hospital
Todd C. Villines, Walter Reed National Military
Yao Lu, New York Presbyterian Hospital

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European Heart Journal Cardiovascular Imaging


© 2020 Published on behalf of the European Society of Cardiology. All rights reserved. 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 <55%, normal 55-65%, and high >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.





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