Relation of Low Normal Left Ventricular Ejection Fraction to Heart Failure Hospitalization in Blacks (From the Jackson Heart Study) - 11/11/20
, Karen A. Valle, PhD c, Chad Blackshear, PhD c, Robert J. Mentz, MD d, Joseph Yeboah, MD e, Carlos J. Rodriguez, MD, MPH e, David M. Herrington, MD e, Takeki Suzuki, MD, MPH, PhD f, Ⅲ Donald Clark, MD a, Ervin R. Fox, MD, MPH a, Amil M. Shah, MD, MPH f, Richard B. Stacey, MD, MS e, William G. Hundley, MD e, Adolfo Correa, MD, MPH, PhD a, Javed Butler, MD, MPH a, Michael E. Hall, MD, MS aHighlights |
• | Low normal ejection fraction (LNEF), which is frequently encountered in clinical practice, is associated with higher risk of incident heart failure (HF) hospitalization in a community-based cohort of African-Americans. |
• | Those with LNEF and diastolic dysfunction may have a particularly higher risk of incident HF hospitalization. |
• | LNEF is associated with a higher risk for incident HF and may be a sign of reducing EF, particularly in African-Americans with LNEF and diastolic dysfunction. |
• | Further longitudinal study in African-Americans is warranted to determine if HF therapies are effective at preventing HF in this group. |
Résumé |
There is no clear consensus on a lower cutoff value for normal left ventricular ejection fraction (EF) and the prognostic implications of low normal EF (LNEF) are poorly understood, particularly in Blacks. Therefore, we investigated the association of LNEF and incident heart failure (HF) in a community-based cohort of Blacks. We studied 3,669 participants (mean age 54 years, 63% women) of the Jackson Heart Study without prevalent HF or coronary heart disease (CHD). Participants were divided into three groups: (1) Reduced EF (<50%), (2) LNEF (≥50%, <55%), and (3) Normal EF (≥55%). There were 197 cases of incident HF hospitalizations over a median follow-up of 10 years (interquartile range 9.4 to 10). After adjustment for conventional risk factors and incident CHD, the LNEF group had a higher rate of incident HF hospitalization than the Normal EF group (HR 1.58, 95% CI 1.04 to 2.38, p<0.05). Furthermore, this relation remained statistically significant after additionally adjusting for LV mass index but was not significant after adjusting for LV diastolic dysfunction grade. In participants with LNEF with incident HF, 63% developed HF with reduced EF and 37% developed HF with preserved EF. In conclusion, LNEF is associated with higher risk of incident HF hospitalization in comparison with normal EF in a community-based cohort of Blacks. In those with LNEF who went on to develop HF, most cases were HF with reduced EF. These findings suggest that strategies are needed for risk stratification and management to improve outcomes in patients with LNEF.
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| The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I) and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD). Michael Hall is funded by NIH/NIDDK 1K08DK099415 and NIH/NIGMS U54GM115428 and P20GM104357. Amil Shah is supported by NIH/NHLBI grants K08HL116792, R01HL135008, and R01HL143224. |
Vol 136
P. 100-106 - décembre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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