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Supranormal Left Ventricular Ejection Fraction, Stroke Volume, and Cardiovascular Risk: Findings From
Sonia Shah1, Matthew W Segar2, Nitin Kondamudi1
1Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
Insights
Supranormal left ventricular ejection fraction (LVEF) in healthy adults is linked to increased cardiovascular risk. This risk is particularly high for individuals with lower stroke volume, highlighting the importance of comprehensive cardiac assessment.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Preventive Cardiology
Background:
- Supranormal ejection fraction (EF) detected by echocardiography is linked to increased cardiovascular disease (CVD) risk in patients.
- The prognostic significance of supranormal left ventricular ejection fraction (LVEF) assessed by cardiac magnetic resonance (CMR) in healthy individuals is not well understood.
Purpose of the Study:
- To examine the prognostic implication of supranormal LVEF measured by CMR.
- To investigate the relationship between supranormal LVEF and stroke volume in community-dwelling adults without CVD.
Main Methods:
- Analysis of participants from the MESA and DHS cohorts without pre-existing CVD.
- Assessment of major adverse cardiovascular events (MACE) risk using adjusted Cox models based on LVEF categories.
- Subgroup analysis of LVEF and MACE risk stratified by left ventricular stroke volume index.
Main Results:
- Higher LVEF (Q4 vs Q1) was associated with increased MACE risk in both MESA and DHS cohorts (MESA HR=1.27, DHS HR=1.72).
- A significant interaction between LVEF and stroke volume index indicated that higher LVEF increased MACE risk primarily in individuals with low stroke volume (P interaction=0.02).
Conclusions:
- Supranormal LVEF in community-dwelling adults without CVD is associated with a higher risk of adverse cardiovascular outcomes.
- The elevated risk is particularly pronounced in individuals with lower stroke volume, underscoring the clinical relevance of this finding.
Background:
Supranormal ejection fraction by echocardiography in clinically referred patient populations has been associated with an increased risk of cardiovascular disease (CVD). The prognostic implication of supranormal left ventricular ejection fraction (LVEF)-assessed by cardiac magnetic resonance (CMR)-in healthy, community-dwelling individuals is unknown.
Objectives:
The purpose of this study is to investigate the prognostic implication of supranormal LVEF as assessed by CMR and its inter-relationship with stroke volume among community-dwelling adults without CVD.
Methods:
Participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) cohorts free of CVD who underwent CMR with LVEF above the normal CMR cutoff (≥57%) were included. The association between cohort-specific LVEF categories and risk of clinically adjudicated major adverse cardiovascular events (MACE) was assessed using adjusted Cox models. Subgroup analysis was also performed to evaluate the association of LVEF and risk of MACE among individuals stratified by left ventricular stroke volume index.
Results:
The study included 4,703 participants from MESA and 2,287 from DHS with 727 and 151 MACE events, respectively. In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs Q1) in both cohorts after accounting for potential confounders (MESA: HR = 1.27 [95% CI: 1.01-1.60], P = 0.04; DHS: HR = 1.72 [95% CI: 1.05-2.79], P = 0.03). A significant interaction was found between the continuous measures of LVEF and left ventricular stroke volume index (P interaction = 0.02) such that higher LVEF was significantly associated with an increased risk of MACE among individuals with low but not high stroke volume.
Conclusions:
Among community-dwelling adults without CVD, LVEF in the supranormal range is associated with a higher risk of adverse cardiovascular outcomes, particularly in those with lower stroke volume.
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