Ejection fraction and mortality: a nationwide register‐based cohort study of 499 153 women and men

Abstract

We investigated the sex-based risk of mortality across the spectrum of left ventricular ejection fraction (LVEF) in a large cohort of patients in Australia.

Piecing together the puzzle of sex‐specific differences in left ventricular ejection fraction

“…Study findings and uncertainties: an overview of the main sex‐specific findings of the study by Stewart et al 6 . (top panel) and the primary sources of uncertainty which need to be explored in further studies (bottom panel).…”

“…In this issue of the journal, Stewart et al 6 investigated the association between sex-specific characteristics of systolic function with outcome. Based on the National Echocardiography Database of Australia (NEDA) they investigated approximately half a million subjects referred for echocardiography, with the specific purpose of exploring the sex-specific association of different LVEF strata with all-cause mortality and cardiovascular-related death.…”

“…The differences in lower limits of normality have, however, been minor (52% for men and 54% for women). 9 As the risk of outcome started to increase at LVEF levels Figure 1 Study findings and uncertainties: an overview of the main sex-specific findings of the study by Stewart et al 6 (top panel) and the primary sources of uncertainty which need to be explored in further studies (bottom panel). CV, cardiovascular; LVEF, left ventricular ejection fraction.…”

“…10,14 With age, women on the other hand have a greater extent of increased left ventricular torsion which seems to preserve LVEF. 6 What causes this difference in myocardial deformation in the presence of cardiac risk factors is unclear, but may rely on gender differences in cellular response with aging as well as differences in geometric adaptions, including the smaller left ventricular cavity size in women. 10,15,16 Thus, in the setting of cardiovascular risk factors, torsional mechanics may be the first sign of progressive left ventricular dysfunction in women, which could translate into an increased risk of adverse outcome while LVEF is either preserved or supranormal.…”

Assessment of prevalence and monitoring of outcomes in patients with heart failure in Russia

“…Анализ прогностической значимости категорий ФВ по данным ЭхоКГ в РКИ и национальных базах данных Австралии (NEDА) [21], США и Англии [22] свидетельствует о J-образной кривой связи общей и сердечно-сосудистой смертности от ФВ. В целом исходы у пациентов с ФВ <50% (особенно при ФВ <30%) хуже по сравнению с пациентами с ФВ >50%.…”