Paul Angaran1, Paul Dorian1, Andrew C T Ha2, Paaladinesh Thavendiranathan3, Wendy Tsang2, Howard Leong-Poi1, Anna Woo2, Bryan Dias4, Xuesong Wang5, Peter C Austin5, Douglas S Lee6. 1. Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada. 2. Peter Munk Cardiac Centre of University Health Network, Toronto, Ontario, Canada. 3. Peter Munk Cardiac Centre of University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada. 4. London Health Sciences Centre, Division of Cardiology, Western University, London, Ontario, Canada. 5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 6. Peter Munk Cardiac Centre of University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada. Electronic address: dlee@ices.on.ca.
Abstract
BACKGROUND: Although echocardiography is widely used to measure left ventricular ejection fraction (LVEF), its prognostic value has not been demonstrated in a broad range of patients including those acutely hospitalized for cardiac or noncardiac causes. We determined whether greater degrees of left ventricular systolic dysfunction were associated with progressively increasing risks of death or cardiovascular hospitalizations among patients in hospital or outpatient settings. METHODS: A total of 27,323 patients with LVEF measured and 19,445 matched controls were followed for 223,034 person-years. Outcomes of total mortality, cardiovascular death, cardiovascular hospitalizations, and heart failure hospitalizations were examined using cause-specific hazard competing-risks analysis. RESULTS: In the study cohort (median age, 68 [interquartile range, 58-77], 14,828 women [31.7%]), the hazard ratios (95% CI) for all-cause death were 1.67 (1.57-1.77), 1.30 (1.24-1.36), and 1.17 (1.11-1.23) when LVEF was <25%, 25%-35%, or 36%-45% compared with LVEF 46%-55% (all P < .001). Rates of cardiovascular death were similarly higher with lower LVEF. The hazard ratios for cardiovascular hospitalization were 1.35 (1.27-1.42), 1.21 (1.16-1.27), and 1.13 (1.07-1.18) for LVEFs <25%, 25%-35%, and 36%-45%, respectively (all P < .001). The rate of heart failure hospitalizations was amplified, with hazard ratios of 1.71 (1.59-1.85), 1.39 (1.31-1.48), and 1.21 (1.13-1.29) for LVEFs <25%, 25%-35%, or 36%-45% (all P < .001). The rate of mortality and hospitalizations increased comparably with greater reductions in LVEF during both inpatient cardiac or noncardiac admissions (P < .001). CONCLUSIONS: Quantitative echocardiographic LVEF stratified the risk of death and hospitalization in a wide range of clinical settings, including during noncardiac admissions.
BACKGROUND: Although echocardiography is widely used to measure left ventricular ejection fraction (LVEF), its prognostic value has not been demonstrated in a broad range of patients including those acutely hospitalized for cardiac or noncardiac causes. We determined whether greater degrees of left ventricular systolic dysfunction were associated with progressively increasing risks of death or cardiovascular hospitalizations among patients in hospital or outpatient settings. METHODS: A total of 27,323 patients with LVEF measured and 19,445 matched controls were followed for 223,034 person-years. Outcomes of total mortality, cardiovascular death, cardiovascular hospitalizations, and heart failure hospitalizations were examined using cause-specific hazard competing-risks analysis. RESULTS: In the study cohort (median age, 68 [interquartile range, 58-77], 14,828 women [31.7%]), the hazard ratios (95% CI) for all-cause death were 1.67 (1.57-1.77), 1.30 (1.24-1.36), and 1.17 (1.11-1.23) when LVEF was <25%, 25%-35%, or 36%-45% compared with LVEF 46%-55% (all P < .001). Rates of cardiovascular death were similarly higher with lower LVEF. The hazard ratios for cardiovascular hospitalization were 1.35 (1.27-1.42), 1.21 (1.16-1.27), and 1.13 (1.07-1.18) for LVEFs <25%, 25%-35%, and 36%-45%, respectively (all P < .001). The rate of heart failure hospitalizations was amplified, with hazard ratios of 1.71 (1.59-1.85), 1.39 (1.31-1.48), and 1.21 (1.13-1.29) for LVEFs <25%, 25%-35%, or 36%-45% (all P < .001). The rate of mortality and hospitalizations increased comparably with greater reductions in LVEF during both inpatient cardiac or noncardiac admissions (P < .001). CONCLUSIONS: Quantitative echocardiographic LVEF stratified the risk of death and hospitalization in a wide range of clinical settings, including during noncardiac admissions.
Authors: Annas Rahman; Max Ruge; Alex Hlepas; Gatha Nair; Joanne Gomez; Jeanne du Fay de Lavallaz; Setri Fugar; Nusrat Jahan; Annabelle Santos Volgman; Kim A Williams; Anupama Rao; Karolina Marinescu; Tisha Suboc Journal: Am Heart J Plus Date: 2022-04-18
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