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Left Ventricular Ejection Fraction Predicts Outcomes in Different Subgroups of Patients Undergoing Coronary
Henning Johann Steffen1,2, Tobias Schupp1,2, Mohammad Abumayyaleh1,2
1Cardiology, Haemostasis, and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, 68167 Mannheim, Germany.
Insights
Reduced left ventricular ejection fraction (LVEF) independently predicts heart failure rehospitalization and acute myocardial infarction in patients undergoing coronary angiography. This finding holds true regardless of the indication for the procedure, highlighting LVEF
Area of Science:
- Cardiology
- Cardiovascular Disease
- Echocardiography
Background:
- Left ventricular ejection fraction (LVEF) is a critical prognostic indicator in cardiovascular disease.
- The prognostic significance of LVEF across diverse indications for coronary angiography (CA) requires further clarification.
Purpose of the Study:
- To assess the long-term predictive capability of LVEF in patients undergoing invasive coronary angiography (CA).
- To determine the association between LVEF and key adverse cardiovascular events, including heart failure (HF) rehospitalization and acute myocardial infarction (AMI).
Main Methods:
- Retrospective analysis of 6888 consecutive patients who underwent CA between January 2016 and August 2022.
- Patients were stratified into four LVEF groups: ≥ 55%, 45-54%, 35-44%, and <35%.
- Primary endpoint: 36-month rehospitalization for HF. Secondary endpoints: AMI and coronary revascularization. Statistical analyses included Kaplan-Meier and multivariable Cox regression.
Main Results:
- Lower LVEF (<35%) correlated with increased comorbidity and more severe coronary artery disease.
- Rehospitalization for HF and AMI rates progressively increased with decreasing LVEF.
- In multivariable analysis, LVEF <35% independently predicted HF rehospitalization (HR=3.731) and AMI (HR=4.184), but not revascularization (HR=0.867).
Conclusions:
- Reduced LVEF is a significant independent predictor of HF rehospitalization and AMI in patients undergoing CA.
- The prognostic value of reduced LVEF is consistent across various indications for CA and patient subgroups.
- No independent association was found between reduced LVEF and the need for coronary revascularization.
Abstract:
Objectives: To evaluate the long-term prognostic value of left ventricular ejection fraction (LVEF) in consecutive patients undergoing invasive coronary angiography (CA). Background: LVEF is a key prognostic marker in cardiovascular disease, but its value across different clinical indications for CA remains insufficiently characterized. Methods: Consecutive patients undergoing CA between January 2016 and August 2022 were retrospectively included at one institution. Patients were stratified into four LVEF groups: ≥ 55%, 45-54%, 35-44%, and <35%. The primary endpoint was rehospitalization for heart failure (HF) at 36 months. Secondary endpoints were acute myocardial infarction (AMI) and coronary revascularization. Kaplan-Meier and multivariable Cox regression analyses were conducted within the entire study cohort and pre-defined subgroups. Results: A total of 6888 patients were included (median age: 71 years; 65.2% males). LVEF < 35% was associated with a higher comorbidity burden and more extensive coronary artery disease (e.g., three-vessel CAD: 38.6% vs. 20.7%, p < 0.001). Event rates for HF rehospitalization and AMI increased progressively with declining LVEF, while revascularization rates varied across categories. Statistically significant differences across LVEF groups were observed for all three endpoints in unadjusted analyses (log-rank p < 0.001). In multivariable models, LVEF < 35% independently predicted HF rehospitalization (HR = 3.731, p < 0.001) and AMI (HR = 4.184, p < 0.001), but not revascularization (HR = 0.867, p = 0.378). The prognostic association was demonstrated across all subgroups stratified by age, sex, subtype of acute coronary syndrome, and CAD severity. Conclusions: Reduced LVEF is an independent predictor of HF rehospitalization and AMI in patients undergoing coronary angiography, irrespective of its indication, whereas no independent association was observed with coronary revascularization.
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