Related Experiment Video
Updated: Jan 26, 2026
Echocardiographic Characterization of Left Ventricular Structure, Function, and Coronary Flow in Neonate Mice
Published on: April 7, 2022
Impact of left ventricular function on clinical outcomes among patients with coronary artery disease
George Cm Siontis1, Mattia Branca2, Patrick Serruys3
11 Department of Cardiology, University Hospital of Bern, Inselspital, Switzerland.
Insights
Patients with reduced or mid-range left ventricular ejection fraction (LVEF) undergoing percutaneous coronary intervention face higher risks of mortality and adverse cardiac events. New LVEF cut-offs improve risk stratification for ischemic heart disease patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Left ventricular ejection fraction (LVEF) is a key prognostic indicator in cardiovascular disease.
- Contemporary LVEF cut-offs are being re-evaluated for improved clinical relevance.
- Coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) represent a significant population for risk stratification.
Purpose of the Study:
- To evaluate the clinical significance of established and proposed LVEF categories in patients with CAD undergoing PCI.
- To assess the prognostic value of mid-range reduced LVEF (40-49%) compared to preserved (≥50%) and reduced (<40%) LVEF.
- To determine the long-term (five-year) risk of mortality and adverse cardiac events across different LVEF strata.
Main Methods:
- Analysis of pooled patient-level data from five randomized clinical trials involving 6198 patients undergoing PCI.
- Categorization of patients into preserved LVEF (≥50%), mid-range reduced LVEF (40-49%), and reduced LVEF (<40%) groups.
- Assessment of all-cause mortality as the primary endpoint, with secondary endpoints including cardiac death and a composite of cardiac death, myocardial infarction, or stroke at five-year follow-up.
Main Results:
- Patients in the reduced LVEF group (<40%) exhibited significantly higher all-cause mortality risk compared to both preserved and mid-range LVEF groups (aHR 2.39 and 1.68, respectively).
- The mid-range reduced LVEF group (40-49%) also showed increased risk for cardiac death and the composite endpoint compared to the preserved LVEF group.
- These increased risks were observed consistently across different baseline clinical presentations (stable CAD or acute coronary syndrome) up to five years.
Conclusions:
- Reduced LVEF (<40%) and mid-range LVEF (40-49%) are associated with significantly increased risks of all-cause mortality, cardiac death, and major adverse cardiovascular events post-PCI in CAD patients.
- The proposed LVEF cut-offs, including the mid-range category, enhance the differentiation and risk stratification of patients with ischemic heart disease.
- These findings support the clinical utility of updated LVEF criteria for guiding management and prognostication in PCI-treated CAD patients.
Aims:
To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention.
Methods And Results:
Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40-49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75-3.28, p < 0.001) and 1.68 (95% confidence interval 1.34-2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons).
Conclusion:
Patients with reduced LVEF <40% or mid-range LVEF 40-49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.
More Related Videos
Related Concept Videos
01:30Coronary Artery Disease III: Clinical Manifestations
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:26Coronary Artery Disease IV: Preventive Measures
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation