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Left Ventricular Ejection Fraction and Incident Cardiac Conduction Dysfunction: Exploring the Mediating Effects of

Qie Zhang1, Feilong Zhang1, Yuhao Hu1

  • 1Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|December 28, 2025
PubMed

Insights

Higher left ventricular ejection fraction (LVEF) independently predicts a lower risk of cardiac conduction dysfunction (CCD). Electrophysiological parameters partially mediate this association, highlighting the importance of mechano-electrical coupling.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Biomedical Engineering

Background:

  • Population-based data on left ventricular ejection fraction (LVEF) predicting cardiac conduction dysfunction (CCD) and electrophysiological mediation is limited.
  • Understanding the relationship between LVEF and incident CCD is crucial for cardiovascular health.
  • This study investigates the predictive role of LVEF and potential mediation by electrophysiological parameters in a large cohort.

Purpose of the Study:

  • To determine if LVEF predicts incident CCD in a large population.
  • To explore the mediating roles of PQ interval, QRS duration, and corrected QT interval in the LVEF-CCD relationship.
  • To elucidate the clinical relevance of myocardial mechano-electrical coupling.

Main Methods:

  • Prospective cohort study of 32,398 UK Biobank participants with LVEF and ECG data.
  • Incident CCD defined as new onset atrioventricular block, left bundle branch block, or other conduction disorders.
  • Cox regression, sensitivity analyses, and mediation analysis (PQ, QRS, QT intervals) were employed.

Main Results:

  • A total of 484 incident CCD cases were identified during ~7 years of follow-up.
  • Each 1-SD increase in LVEF was associated with a 17% reduced risk of CCD (aHR=0.83, p<0.001).
  • PQ interval, QRS duration, and corrected QT interval mediated 6%, 17%, and -3% of the LVEF-CCD association, respectively.

Conclusions:

  • LVEF is an independent predictor of incident CCD.
  • Electrophysiological parameters partially mediate the association between LVEF and CCD.
  • Findings emphasize the clinical significance of myocardial mechano-electrical coupling in population health.
Abstract

Keywords:
electrophysiological parametersincident cardiac conduction dysfunctionleft ventricular ejection fractionmediation factorspredictive value

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