Abstract 13370: The Relationship Between Longitudinal Changes in Left Ventricular Ejection Fraction and Survival From 57,823 Patients in a Large Regional Health System

Abstract

Introduction: An intriguing U-shape relationship between left ventricular ejection fraction (LVEF) and survival has recently been reported, with LVEFs of 60-65% associated with the lowest mortality risk. In heart failure, LVEF recovery has been linked to improved outcomes; however, the relationship between changes in LVEF (ΔLVEF) and survival in a general clinical population has not been studied. We hypothesized that ΔLVEF would have a non-linear relationship with all-cause mortality. Methods: A total of 194,599 echocardiograms from 57,823 patients with physician-reported LVEF were identified from Geisinger health records, along with dates of death or last living encounter, age, sex, smoking status, height, weight, and active diagnoses. ΔLVEF for a given echocardiogram was calculated for 136,776 studies as the difference between the most recent previous and current LVEF. Cox Proportional Hazards Regression was used to relate interaction between ΔLVEF and current LVEF to all-cause mortality while adjusting for confounders. Results: Death occurred in 15,419 patients who underwent 39,562 (29%) echocardiograms. Median follow up duration was 3.6 years (IQR, 1.3-7.2), and median time between tests was 1.0 year (IQR, 0.2-2.3). The interaction between LVEF and ΔLVEF ( P < 0.001) demonstrated that a stable LVEF of 60-65% was associated with the best survival (Figure). A decreased LVEF was universally associated with increased mortality, while LVEFs that had increased showed non-linear interactions. In general, an LVEF of 35-55% that had increased from the previous test was associated with a similar or slightly lower mortality than the same LVEF that was unchanged or had decreased, while an LVEF >55% that had increased was associated with an increase in mortality risk compared to those with a stable LVEF. Conclusions: Changes in LVEF have a non-linear relationship with all-cause mortality. In general, a constant, stable LVEF associates with the lowest risk of mortality.