Abstract 13226: Shorter Left Ventricular Ejection Time is Associated With Adverse Outcomes in Heart Failure Patients With Reduced Ejection Fraction

Abstract

Introduction: Worsening heart failure (HF) is thought to be associated with shorter left ventricular ejection time (LVET), but there are limited data describing the relationship between LVET and outcomes. We report the largest study to date describing the association between LVET and outcomes in an ambulatory HF population. Methods: We identified HF patients without significant structural or congenital heart disease who had an outpatient transthoracic echocardiogram (TTE) performed between 8/2008-7/2010 at Duke University Medical Center. We excluded patients with paced or irregular rhythms. All TTE were re-analyzed in triplicate. Multivariable logistic regression was used to evaluate the association between LVET and 1 year outcomes among HF patients with reduced ejection fraction (HFrEF) and patients with preserved ejection fraction (HFpEF). Results: We identified 545 HF patients (171 HFrEF, 374 HFpEF) meeting inclusion criteria. HFrEF patients were younger (median age was 60 (Quartile 1 to Quartile (Q1-Q3) 50-69) vs. 64 (Q1-Q3 53-74), with smaller proportion of females (30.4 vs. 56.4%) and similar ratio of African Americans (35.7 vs. 35.0%). Median EF among patients with HFrEF was 30% (Q1-Q3 25-35%) and with HFpEF was 54% (Q1-Q3 48-58%). There were no statistical differences in medical histories or neurohormonal therapies. Median LVET was shorter (280 vs. 315ms, p<0.001), median pre-ejection period was longer (114 vs. 89ms, p<0.001), and median relaxation time was shorter (351 vs 411ms, p<0.001) among patients with HFrEF versus HFpEF. Death or HF hospitalization occurred in 46/171 HFrEF patients and 44/374 HFpEF patients. After adjustment, longer LVET was associated with lower odds of the composite of 1 year death/1 year HF hospitalization among HFrEF patients, but not among HFpEF (Table). Conclusion: Longer LVET is independently associated with improved outcomes among HFrEF patients supporting a potential role for increasing LVET as a therapeutic target.