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Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and

R S Vasan1, M G Larson, E J Benjamin

  • 1National Heart, Lung, and Blood Institute's Framingham Heart Study, Massachusetts 01702, USA.

Journal of the American College of Cardiology
|June 11, 1999
PubMed

Insights

Congestive heart failure (CHF) with normal left ventricular (LV) systolic function is common in the community, particularly in women. These patients face a fourfold increased mortality risk compared to those without CHF.

Area of Science:

  • Cardiology
  • Echocardiography
  • Public Health

Background:

  • Hospital studies indicate many congestive heart failure (CHF) patients have normal left ventricular (LV) systolic function.
  • The community prevalence and prognosis of CHF with normal LV systolic function remain unclear.

Purpose of the Study:

  • To determine the proportion of normal versus impaired LV systolic function in community-dwelling CHF patients.
  • To compare long-term mortality between CHF patients with normal and impaired LV systolic function and matched controls.

Main Methods:

  • A nested case-control study evaluated 73 Framingham Heart Study subjects with CHF and 146 matched controls.
  • Impaired LV systolic function was defined as LV ejection fraction (LVEF) <0.50.
  • Echocardiograms were analyzed, and mortality data were collected over a median follow-up of 6.2 years.

Main Results:

  • 51% of CHF cases exhibited normal LVEF; 49% had reduced LVEF. Normal LVEF was more prevalent in women (65%), while reduced LVEF predominated in men (75%).
  • CHF cases with normal LVEF had an 8.7% annual mortality vs. 3.0% for controls (aHR=4.06).
  • CHF cases with reduced LVEF had an 18.9% annual mortality vs. 4.1% for controls (aHR=4.31).

Conclusions:

  • Normal LV systolic function is frequent in community-based CHF and more common in women.
  • While having lower mortality than reduced LVEF CHF, normal LVEF CHF patients face a fourfold increased mortality risk compared to non-CHF controls.
Abstract

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