Catherine Gebhard1,2, Monika Maredziak1,2, Michael Messerli1, Ronny R Buechel1, Fay Lin3, Heidi Gransar4, Stephan Achenbach5, Mouaz H Al-Mallah6, Daniele Andreini7, Jeroen J Bax8, Daniel S Berman9, Matthew J Budoff10, Filippo Cademartiri11, Tracy Q Callister12, Hyuk-Jae Chang13, Kavitha Chinnaiyan14, Benjamin J W Chow15, Ricardo C Cury16, Augustin DeLago17, Gudrun Feuchtner18, Martin Hadamitzky19, Joerg Hausleiter20, Yong-Jin Kim21, Jonathon Leipsic22, Erica Maffei23, Hugo Marques24, Pedro de Araújo Gonçalves24, Gianluca Pontone7, Gilbert L Raff14, Ronen Rubinshtein25, Leslee J Shaw3, Todd C Villines26, Yao Lu27, Erica C Jones3, Jessica M Peña3, James K Min3, Philipp A Kaufmann1. 1. Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. 2. Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland. 3. Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 1300 York Avenue, New York, NY 10065, USA. 4. Department of Imaging, Cedars-Sinai Medical Center, 8705 Gracie Allen Dr, Los Angeles, CA 90048, USA. 5. Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Maximiliansplatz 2, 91054 Erlangen, Germany. 6. King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Ar Rimayah, Riyadh 14611, Saudi Arabia. 7. Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea, 4, 20138 Milan, Italy. 8. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, The Netherlands. 9. Department of Imaging and Medicine, Cedars Sinai Medical Center, 8705 Gracie Allen Dr, Los Angeles, CA, USA. 10. Department of Medicine, Los Angeles Biomedical Research Institute, 1124 W Carson St, Torrance, CA 90502, USA. 11. Cardiovascular Imaging Center, SDN IRCCS, via Gianturco 113, 80143 Naples, Italy. 12. Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd, Hendersonville, TN 37075, USA. 13. Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea. 14. Department of Cardiology, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA. 15. Department of Medicine and Radiology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. 16. Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA. 17. Capitol Cardiology Associates, Corporate Woods 7 Southwoods Blvd., Albany, NY 12211, USA. 18. Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020 Innsbruck, Austria. 19. Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 Munich, Germany. 20. Medizinische Klinik I der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany. 21. Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, South Korea. 22. Department of Medicine and Radiology, University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada. 23. Department of Radiology, Area Vasta 1/ASUR Marche, Viale Federico Comandino, 70, 61029 Urbino, Italy. 24. UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Avenida Lusíada, 100, 1500-650 Lisboa, Portugal. 25. Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa 34362, Israel. 26. Cardiology Service, Walter Reed National Military Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. 27. Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, 402 E. 67th Street, New York, NY 10065, USA.
Abstract
AIMS: There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men. METHODS AND RESULTS: A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low <55%, normal 55-65%, and high >65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD). CONCLUSION: Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01443637. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men. METHODS AND RESULTS: A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low <55%, normal 55-65%, and high >65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD). CONCLUSION: Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01443637. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Filippo Crea; C Noel Bairey Merz; John F Beltrame; Juan Carlos Kaski; Hisao Ogawa; Peter Ong; Udo Sechtem; Hiroaki Shimokawa; Paolo G Camici Journal: Eur Heart J Date: 2017-02-14 Impact factor: 29.983
Authors: Giovanni De Simone; Richard B Devereux; Marcello Chinali; Mary J Roman; Ana Barac; Julio A Panza; Elisa T Lee; Barbara V Howard Journal: J Hypertens Date: 2011-07 Impact factor: 4.844
Authors: Philip A Poole-Wilson; Karl Swedberg; John G F Cleland; Andrea Di Lenarda; Peter Hanrath; Michel Komajda; Jacobus Lubsen; Beatrix Lutiger; Marco Metra; Willem J Remme; Christian Torp-Pedersen; Armin Scherhag; Allan Skene Journal: Lancet Date: 2003-07-05 Impact factor: 79.321
Authors: Nisha Arenja; Thomas Fritz; Florian Andre; Johannes H Riffel; Fabian Aus dem Siepen; Marco Ochs; Judith Paffhausen; Ute Hegenbart; Stefan Schönland; Matthias Müller-Hennessen; Evangelos Giannitsis; Arnt V Kristen; Hugo A Katus; Matthias G Friedrich; Sebastian J Buss Journal: Eur Heart J Cardiovasc Imaging Date: 2017-12-01 Impact factor: 6.875
Authors: Steffen E Petersen; Nay Aung; Mihir M Sanghvi; Filip Zemrak; Kenneth Fung; Jose Miguel Paiva; Jane M Francis; Mohammed Y Khanji; Elena Lukaschuk; Aaron M Lee; Valentina Carapella; Young Jin Kim; Paul Leeson; Stefan K Piechnik; Stefan Neubauer Journal: J Cardiovasc Magn Reson Date: 2017-02-03 Impact factor: 5.364
Authors: Joseph R Paonessa; Thomas Brennan; Marco Pimentel; Daniel Steinhaus; Mengling Feng; Leo Anthony Celi Journal: Crit Care Date: 2015-08-07 Impact factor: 9.097
Authors: Nidaa Mikail; Alexia Rossi; Susan Bengs; Ahmed Haider; Barbara E Stähli; Angela Portmann; Alessio Imperiale; Valerie Treyer; Alexander Meisel; Aju P Pazhenkottil; Michael Messerli; Vera Regitz-Zagrosek; Philipp A Kaufmann; Ronny R Buechel; Cathérine Gebhard Journal: Eur J Nucl Med Mol Imaging Date: 2022-08-17 Impact factor: 10.057
Authors: Enrique Santas; Patricia Palau; Pau Llácer; Rafael de la Espriella; Gema Miñana; Gonzalo Núñez-Marín; Miguel Lorenzo; Raquel Heredia; Juan Sanchis; Francisco Javier Chorro; Antoni Bayés-Genís; Julio Núñez Journal: J Am Heart Assoc Date: 2021-12-20 Impact factor: 6.106
Authors: Nikolaos Karamichalakis; Andrew Xanthopoulos; Filippos Triposkiadis; Ioannis Paraskevaidis; Elias Tsougos Journal: J Clin Med Date: 2022-06-27 Impact factor: 4.964