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Increased long-term mortality in women with high left ventricular ejection fraction: data from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) long-term registry

Authors
 Catherine Gebhard  ;  Monika Maredziak  ;  Michael Messerli  ;  Ronny R Buechel  ;  Fay Lin  ;  Heidi Gransar  ;  Stephan Achenbach  ;  Mouaz H Al-Mallah  ;  Daniele Andreini  ;  Jeroen J Bax  ;  Daniel S Berman  ;  Matthew J Budoff  ;  Filippo Cademartiri  ;  Tracy Q Callister  ;  Hyuk-Jae Chang  ;  Kavitha Chinnaiyan  ;  Benjamin J W Chow  ;  Ricardo C Cury  ;  Augustin DeLago  ;  Gudrun Feuchtner  ;  Martin Hadamitzky  ;  Joerg Hausleiter  ;  Yong-Jin Kim  ;  Jonathon Leipsic  ;  Erica Maffei  ;  Hugo Marques  ;  Pedro de Araújo Gonçalves  ;  Gianluca Pontone  ;  Gilbert L Raff  ;  Ronen Rubinshtein  ;  Leslee J Shaw  ;  Todd C Villines  ;  Yao Lu  ;  Erica C Jones  ;  Jessica M Peña  ;  James K Min  ;  Philipp A Kaufmann 
Citation
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol.21(4) : 363-374, 2020-04 
Journal Title
EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
ISSN
 2047-2404 
Issue Date
2020-04
Keywords
cardiovascular ; coronary computed tomography angiography ; gender ; left ventricular ejection fraction ; women
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.
Full Text
https://academic.oup.com/ehjcimaging/article/21/4/363/5716358
DOI
10.1093/ehjci/jez321
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179157
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