Increased Mortality of High versus Normal Ejection Fraction – Insights from Big Echo Data

Abstract

Mortality with impaired left ventricular ejection fraction (LVEF) has been demonstrated. However, the prevalence and significance of increased LVEF in the community is unclear. We used the National Echo Database Australia (NEDA) to compare mortality in patients with normal and high LVEF. Methods: 331,344 individuals aged >18 years (52% men, age = 60.8 ± 18.0 years) had a mean follow up of 5.4 person-years and 63,142 fatal events. LVEF using Method of Discs could be calculated in 116,544 individuals. We compared mortality in those with normal LVEF compared with high LVEF for males and females. Results: Mortality was 11% higher in females with high LVEF vs normal LVEF. On multivariable logistic regression, high ejection fraction remained an independent predictor of mortality after correction for age, gender and body mass index. High LVEF was associated with female gender, age and diastolic dysfunction. Of 96,033 individuals in the study population, 44,282 males had normal LVEF (52–72%) as opposed to 2,594 with high LVEF (>72%). In females, 46,186 had normal LVEF (54–74%) and 2,971 had high LVEF. In Cox proportional hazard models, the hazard ratio (HR) for mortality in males with normal EF was 1.105 for age (95% CI 1.102 to 1.07) and 1.074 (95% CI 0.988 to 1.167) for high LVEF (p < 0.001 for all outputs). In females, the corresponding adjusted HR was 1.107 for age (95% CI 1.105 to 1.110) and 1.140 for high LVEF (95% CI 1.057 to 1.230). Conclusion: High LVEF, particularly in older women, is associated with increased mortality compared with normal LVEF.