The risk of cardiovascular disease or death among a healthy population with mildly reduced and preserved left ventricular ejection fraction

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Abstract Aims We investigated the relationship between mildly reduced and preserved left ventricular ejection fraction (LVEF) and cardiovascular morbidity and all-cause mortality, in a healthy community-based cohort. Methods and results A total of 20,385 echocardiograms of healthy individuals with LVEF≥45%, were collected at a tertiary university medical center, between 2002-2015. Participants were divided into three groups: 209 with mildly reduced (45-50%), 1,709 with preserved (50-55%), and 18,467 with normal (>55%) LVEF. Based on data from electronic medical records and multiple Cox regression analyses, we examined all-cause mortality (primary outcome) and major adverse cardiovascular events (MACE) which included: stable ischemic heart disease, acute coronary syndrome, heart failure, percutaneous coronary intervention, coronary artery bypass graft, and stroke (secondary outcome). The mean follow-up period was 7±4 years. Mean age was 33±10 years, 52.6% were females. Prevalence of death and MACE was 2.9% and 31% for mildly reduced LVEF, 1.8% and 10% for preserved LVEF, and 0.7% and 7.4% for normal LVEF, respectively. In multivariable-adjusted analyses, mildly reduced LVEF was related to increased risk of death [hazard ratio (HR) 3.58; 95% confidence interval (CI) 1.55-8.28] and MACE [HR 4.31; 95% CI 3.21- 5.79], followed by preserved LVEF ([HR 2.38; 95% CI 1.57-3.62] and [HR 1.36; 95% CI 1.14-1.61] for death and MACE, respectively), compared to normal LVEF. Conclusion In a healthy adult population, mildly reduced and preserved LVEF are associated with gradually higher all-cause mortality and cardiovascular morbidity, compared to normal LVEF. These results suggest that LVEF should be used as a novel parameter in cardiovascular disease prediction algorithms to reduce the prevalence of cardiovascular morbidity and mortality.