Prevalence Of Left Ventricular Ejection Fraction Research Articles

A smartphone based AI model to detect left ventricular systolic dysfunction on 12-lead ECG

Abstract Background Despite echocardiography being essential for cardiac assessment, a point-of-care tool for rapid left ventricular ejection fraction (LVEF) evaluation is lacking in current clinical practice, highlighting the need for a widescale, easily deployable method to assess LV function. Purpose To develop and validate two artificial intelligence (AI) models that accurately detect reduced LVEF on a single 12-lead ECG using a smartphone, facilitating early identification of patients at risk for heart failure who may benefit from more detailed echocardiographic evaluation. Methods A large collection of ECGs and transthoracic echocardiograms (TTEs) was sourced from our hospital data vault from 2011 to 2021. ECGs were paired to TTEs within a 24h time window and the resulting pairs were randomly assigned to the model development dataset (50%) and validation dataset (50%). Two distinct AI-ECG models were developed: one to detect LVEF≤40% and another for LVEF<50%, derived from the ESC definition of heart failure. Both AI-ECG models were paired with smartphone based ECG digitization technology. Key performance metrics include area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1-score. Results A total of 1,205,370 ECGs (198,274 patients) and 291,433 TTEs (105,849 patients) were collected and paired, resulting in 109,809 ECG-TTE pairs (56,236 patients). The validation dataset consisted of 25,510 distinct TTE-ECG pairs (25,510 patients). Prevalence of LVEF≤40% and LVEF<50% was 5.4% and 7.9% respectively. The LVEF≤40% model demonstrated an AUC of 0.963 (95% CI: 0.959-0.966), sensitivity 0.924 (95% CI: 0.91-0.937), specificity 0.887 (95% CI: 0.883-0.891), and F1-score of 0.474 (95% CI: 0.457-0.490). PPV and NPV were 0.318 (95% CI: 0.304-0.333) and 0.995 (95% CI: 0.994-0.996) respectively. Performance of the LVEF <50% model shows an AUC of 0.952 (95% CI: 0.947-0.956), with a slightly lower sensitivity of 0.899 (95% CI: 0.886-0.912), specificity of 0.875 (95% CI: 0.871-0.879), PPV of 0.382 (95% CI: 0.368-0.395), NPV of 0.99 (95% CI: 0.989-0.992), and F1-score of 0.536 (0.521-0.55). Conclusion The AI models exhibit the ability to identify reduced LVEF from standard 12-lead ECGs using a smartphone. Results suggest potential clinical utility as a preliminary screening tool to select patients for confirmatory echocardiography. This AI application could potentially offer a timely and cost-effective method for identifying patients at risk for future development of heart failure.

Association between Anti-Erythropoietin Receptor Antibodies and Cardiac Function in Patients on Hemodialysis: A Multicenter Cross-Sectional Study.

Cardiac dysfunction is an important prognostic predictor of cardiovascular mortality in patients on hemodialysis (HD). Erythropoietin (EPO) has been reported to improve cardiac function by binding to the EPO receptor (EPOR) on cardiomyocytes. This study investigated whether anti-EPOR antibodies were associated with left ventricular cardiac function in patients undergoing HD. This multicenter, cross-sectional observational study included 377 patients (median age, 70 years; 267 (70.8%) males) with chronic kidney disease (CKD) undergoing stable maintenance HD. Serum levels of anti-EPOR antibodies were measured, and echocardiography was used to assess the left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Anti-EPOR antibodies were found in 17 patients (4.5%). LVMI was greater (median of 135 g/m2 vs. 115 g/m2, p = 0.042), and the prevalence of LVEF < 50% was higher (35.3% vs. 15.6%, p = 0.032) in patients with anti-EPOR antibodies than in those without. Multivariable linear regression and logistic regression analysis (after adjusting for known risk factors of heart failure) revealed that anti-EPOR antibodies were independently associated with LVMI (coefficient 16.2%; 95% confidence interval (CI) 1.0–35.0%, p = 0.043) and LVEF <50% (odds ratio 3.20; 95% CI 1.05–9.73, p = 0.041). Thus, anti-EPOR antibody positivity was associated with left ventricular dysfunction in patients undergoing HD.

Effect of Guideline-Based Therapy on Left Ventricular Systolic Function Recovery After ST-Segment Elevation Myocardial Infarction

Little is known about the proportion of ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention, who have reduced left ventricular ejection fraction (LVEF) within 48 hours (baseline) of admission and exhibit LVEF recovery under optimal guideline-based medical treatment. Therefore, the present study evaluates the evolution of LVEF in patients after STEMI and under guideline-based medical therapy. In 2,853 STEMI patients treated with primary percutaneous coronary intervention, echocardiography was performed at baseline and at 6 months follow-up. Patients with previous myocardial infarction, reinfarction, coronary artery bypass grafting or incomplete echocardiographic data at 6 months follow-up were excluded. Reduced LVEF at baseline was defined as <40%. LVEF recovery was defined as LVEF >50% at 6 months follow-up. The prevalence of LVEF <40% at baseline was 13% (n = 371 patients; mean age 60 [range 33 to 88] years; 76% men). At follow-up, 31% of patients remained with a LVEF <40%, 30% showed a LVEF between 41% and 49% and in 39% of patients LVEF improved to >50%. There were no differences in usage of guideline-based medications at discharge across groups. On multivariable analysis, peak troponin T levels (odds ratio [OR] 0.895; p < 0.001), baseline LVEF (OR 1.069; p = 0.023) and absence of significant mitral regurgitation (OR 0.376; p = 0.018) were independently associated with LV recovery at follow-up. In conclusion, the prevalence of LVEF <40% is low. With optimal medical therapy, LVEF normalizes in 39% of patients. Smaller enzymatic infarct size, baseline LVEF and absence of mitral regurgitation were independently associated with LVEF recovery at follow-up.

Lipoprotein(a) is associated with left ventricular systolic dysfunction in a Chinese population of patients with hypertension and without coronary artery disease.

IntroductionData on relationship between lipoprotein(a) (Lp(a)) and non-ischemic heart dysfunction are limited. This study is aimed to assess the association between Lp(a) and left ventricular systolic dysfunction in a Chinese population of patients with hypertension and without coronary artery disease (CAD).Material and methodsThis cross-sectional study included 1611 patients with hypertension and without CAD in China. The factors associated with left ventricular ejection fraction (LVEF) were evaluated using univariate and multivariate analysis.ResultsA higher percentage of hypertensive patients with LVEF < 50% were men, and had lower plasma high-density lipoprotein cholesterol, but higher plasma Lp(a), serum creatinine, and hemoglobin levels than those with LVEF ≥ 50% using univariate analysis. When participants were classified as four groups according to Lp(a) quartiles, LVEF was decreased with increased Lp(a) levels. The prevalence of LVEF < 50% was increased with Lp(a) quartiles. Multiple linear regression analysis indicated that plasma Lp(a) levels, man, and serum creatinine levels were independently correlated with LVEF in hypertensive patients. Multiple logistic regression analysis indicated that plasma Lp(a) levels (OR = 5.566, 95% CI: 1.745–17.758, p = 0.004) or Lp(a) quartiles (quartile 4: OR = 3.234, 95% CI: 1.290–8.105, quartile 1 as reference, p = 0.012) was independently correlated with LVEF < 50% with adjustment for other potential confounders. Ordinal logistic regression analysis demonstrated that Lp(a) (OR = 5.760, 95% CI: 1.831–18.120, p = 0.003) was independently correlated with different LVEF categories (≥ 50%, 35–49%, and < 35%) in hypertensive patients.ConclusionsLeft ventricular ejection fraction is decreased with increased plasma Lp(a) levels. Lipoprotein(a) is independently correlated with left ventricular systolic dysfunction in patients with hypertension and without CAD.

The Association Between Alcohol Consumption and Left Ventricular Ejection Fraction: An Observational Study on a General Population.

The results of previous studies on the relation between alcohol consumption and heart failure (HF) have been inconsistent. This study aimed to evaluate the association between alcohol consumption and left ventricular ejection fraction (LVEF) in a general population.A total of 10,824 adults were examined using a multistage cluster sampling method to select a representative sample of individuals who were at least 35-years old. The participants were asked to provide information about their alcohol consumption. Echocardiograms were obtained, and LVEF was calculated using modified Simpson's rule.Of the 10,824 participants included in the present study, 46.1% were males, and the mean participant age was 54 years; age ranged from 35 to 93 years. The overall prevalence of LVEF< 0.50 and LVEF < 0.40 in the studied population was 11.6% and 2.9%, respectively. The prevalence of LVEF < 0.5 and LVEF < 0.04 was higher in both the moderate and heavy drinker groups than in the nondrinker group (P <0.05). Multivariate logistic regression analyses corrected according to the different levels of alcohol consumption showed that moderate and heavy drinkers had an –1.3-fold and 1.2-fold higher risk of LVEF <0.5, respectively, than nondrinkers (OR: 1.381, 95% CI: 1.115–1.711, P = 0.003 for moderate drinkers; OR: 1.246, 95% CI: 1.064–1.460, P = 0.006 for heavy drinkers). Heavy drinkers had an ∼1.5-fold higher risk of decreased LVEF < 0.4 than nondrinkers (OR: 1.482, 95% CI: 1.117–1.965, P = 0.006). Moderate drinkers did not show a risk of decreased LVEF < 0.4 that was significantly higher than that of nondrinkers (OR: 1.183, 95% CI: 0.774–1.808, P = 0.437).According to these results, we concluded that increased alcohol consumption was associated with decreased LVEF compared with no alcohol consumption in this general population.