Abstract 9998: Prognosis of Low Normal Left Ventricular Ejection Fraction in an Asymptomatic Population -based Adult Cohort. MESA

Abstract

Introduction: A reduced left ventricular ejection fraction (LVEF) is associated with adverse cardiovascular events; however, the optimal threshold for a “normal” LVEF is uncertain. In general a LVEF ≥ 55% is considered “normal” by guidelines, with a low normal designation for LVEF 50-55%. We assess the prognosis of participants with low normal LVEF (LN-EF) in the Multi Ethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical CVD at baseline. Methods: 4669 out of 5004 had LVEF of ≥ 50% assessed using cardiac MRI (SSFP), had no significant valvular disease (- VD), did not have MI during follow up (-MI), had complete data and included in analysis. 475/4669(10.2%) had LN-EF. Cox proportional hazard and cubic spline analyses were used to assess the association of low normal LVEF and 10 years of adjudicated incident congestive heart failure(CHF) and all- cause mortality adjusting for age gender and race( model 1) and model 2: model 1 + DM, smoking, SBP, BP meds, BMI, creatinine, LDL, family history and educational status. Model 3: model 2 + LV mass. Results: Age averaged 61± 10yrs, 46% were men, 35% had BP meds, 8% T2DM. After 10.2 years of follow up, 112 developed CHF and 425 died. 87/112 CHF events had LVEF available at diagnosis [45 had a LVEF≥ 50%-HFPEF and 42 had LVEF<50%-HFREF]. Table 1 shows our results.. Using LVEF of 55% as reference the risk of CHF in individuals with LVEF≥ 50% is non- linear (Figure 1). Conclusion: In asymptomatic population based adults -VD, -MI, LN-EF is prevalent(10.2%) and is an independent predictor of future clinical CHF. LN-EF is not associated with mortality. Future CHF prevention measures should also focus on individuals with LN-EF.