Abstract 9884: Supranormal Left Ventricular Ejection Fraction and Risk of Major Adverse Cardiovascular Events: Findings from the Multi-Ethnic Study of Atherosclerosis and Dallas Heart Study

Abstract

Introduction: Left ventricular (LV) systolic dysfunction is associated with a higher risk of adverse cardiovascular (CV) outcomes. However, the prognostic implication of supranormal LV ejection fraction (LVEF), as assessed by cardiac MRI, among adults with no prior CV disease (CVD) is unknown. Methods: Participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and Dallas Heart Study (DHS) who were free of CVD at baseline and underwent cardiac MRI with LVEF above the normal MRI cutoff (≥57%) were included. The association between cohort specific LVEF categories and risk of clinically adjudicated major adverse CV events (MACE) was assessed using adjusted Cox models. The association between continuous measures of LVEF and risk of MACE was assessed in a pooled cohort analysis using cohort-specific Z-scores of LVEF. Results: There were 4,703 participants from MESA (mean age 62, 25% black, 54% women, median follow up 13.1 years) and 2,287 participants from DHS (mean age 44, 46% black, 57% women, median follow up 12 years) with 747 and 151 MACE events, respectively. In both cohorts, participants across increasing LVEF quartiles (MESA Q1 mean LVEF=63% vs. Q4 mean LVEF=78%) were older and had a higher burden of CV risk factors. Among cardiac parameters, across increasing quartiles, LV end-diastolic volume (Q1: 69.9 vs. Q4: 64.6 ml/m2) and LV mass (Q1: 79.1 vs. Q4: 74.9 gm/m2) significantly decreased (p<0.001), while LV stroke volume (Q1: 43.8 vs. Q4: 49.8 ml/m2) increased (p<0.001). In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs. Q1) in both cohorts (Figure A). Similar patterns of association were observed between continuous distribution of LVEF and risk of MACE in the pooled analysis (Figure B). Conclusions: Among community-dwelling adults without CVD, supranormal LVEF is associated with elevated risk of MACE. Future studies are needed to elucidate the mechanisms underlying risk of CVD among individuals with supranormal LVEF.