Background: Although women are known to have a relatively higher left ventricular ejection fraction (LVEF) compared with men, a sex-neutral LVEF threshold continues to be used for clinical management. We sought to investigate the relationship among high (>65%), normal (55%-65%) and low (<55%) LVEF and long-term all-cause mortality and major adverse cardiovascular events (MACEs) in women presenting with suspected myocardial ischaemia.
Methods: A total of 734 women from the Women's Ischemia Syndrome Evaluation (WISE) were analysed. LVEF was calculated by invasive left ventriculography. The relationship between baseline characteristics, LVEF and outcomes was evaluated. A multivariable Cox regression model was used to assess the association of LVEF with outcomes, after adjusting for known risk factors.
Results: Low LVEF was associated with higher rates of mortality and MACE compared with normal and high LVEF (p<0.0001). Normal LVEF was associated with higher mortality (p=0.047) and rate of myocardial infarctions (MIs) compared with high LVEF (p=0.03). Low LVEF remained a significant predictor of mortality compared with high LVEF (p=0.013) in a multivariable regression model and normal compared with high LVEF trended towards higher mortality (p=0.16).
Conclusion: Among women with suspected ischaemia, women with LVEF above the defined normal threshold (>65%) had lower rates of all-cause mortality and non-fatal MI. Further investigation is needed to determine the optimal LVEF in women.
Trial Registration Number: NCT00000554.
Competing Interests: Competing interests: CNBM serves as Board of Director for iRhythm and SHL Telemedicine and receives personal fees paid through CSMC from Abbott Diagnostics and Phillips. All other authors report no disclosures. EH reports grants from NIH/NHLBI, during the conduct of the study; grants from Aastom Biosciences, Amgen, Amorcyte, AstraZeneca, Biocardia, Boehringer Ingelheim, Brigham and Women’s Hospital, Capricor, Cytori Therapeutics, Department of Defense, Direct Flow Medical, Duke Clinical Research Institute, East Carolina University, Everyfit Inc, Gilead, Ionis, Medtronic, Merck grants from NIH/NCATS, grants from BioCardia BC-14-001-02; Mesoblast, Inc. MSB-MPC-CHF001; Ventrix, Inc; Athersys Inc. AMI MultiStem; Verily Life Sciences LLC-Project Baseline OSMB; Ironwood MSB-MPC-CHF00-DMC, Imbria Pharmaceuticals Inc; Milestone Pharmaceuticals Inc; Caladrius Biosciences, Inc; Gatorade Trust; and McJunkin Family Foundation, outside the submitted work.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)