@article{36bc55ef64944b8ca6804485f56a4af2,
title = "Increased long-term mortality in women with high left ventricular ejection fraction: Data from the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) long-term registry",
abstract = "Aims: There are significant sex-specific differences in left ventricular ejection fraction (LVEF), with a higher LVEF being observed in women. We sought to assess the clinical relevance of an increased LVEF in women and men. Methods and results: A total of 4632 patients from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry (44.8% women; mean age 58.7 ± 13.2 years in men and 59.5 ± 13.3 years in women, P = 0.05), in whom LVEF was measured by cardiac computed tomography, were categorized according to LVEF (low 65%). The prevalence of high LVEF was similar in both sexes (33.5% in women and 32.5% in men, P = 0.46). After 6 years of follow-up, no difference in mortality was observed in patients with high LVEF in the overall cohort (P = 0.41). When data were stratified by sex, women with high LVEF died more often from any cause as compared to women with normal LVEF (8.6% vs. 7.1%, log rank P = 0.032), while an opposite trend was observed in men (5.8% vs. 6.8% in normal LVEF, log rank P = 0.89). Accordingly, a first order interaction term of male sex and high LVEF was significant (hazard ratios 0.63, 95% confidence intervals 0.41-0.98, P = 0.043) in a Cox regression model of all-cause mortality adjusted for age, cardiovascular risk factors, and severity of coronary artery disease (CAD). Conclusion: Increased LVEF is highly prevalent in patients referred for evaluation of CAD and is associated with an increased risk of death in women, but not in men. Differentiating between normal and hyperdynamic left ventricles might improve risk stratification in women with CAD.",
keywords = "cardiovascular, coronary computed tomography angiography, gender, left ventricular ejection fraction, women",
author = "Catherine Gebhard and Monika Maredziak and Michael Messerli and Buechel, {Ronny R.} and Fay Lin and Heidi Gransar and Stephan Achenbach and Al-Mallah, {Mouaz H.} and Daniele Andreini and Bax, {Jeroen J.} and Berman, {Daniel S.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Augustin Delago and Gudrun Feuchtner and Martin Hadamitzky and Joerg Hausleiter and Kim, {Yong Jin} and Jonathon Leipsic and Erica Maffei and Hugo Marques and Gon{\c c}alves, {Pedro De Ara{\'u}jo} and Gianluca Pontone and Raff, {Gilbert L.} and Ronen Rubinshtein and Shaw, {Leslee J.} and Villines, {Todd C.} and Yao Lu and Jones, {Erica C.} and Pe{\~n}a, {Jessica M.} and Min, {James K.} and Kaufmann, {Philipp A.}",
note = "Funding Information: This work is supported by the National Heart, Lung and Blood Institute under award number R01HL115150 and also in part by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation. C.G. is supported by grants from the Swiss National Science Foundation (SNSF, grant #163892), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, the Swiss Heart Foundation, the Helmut Horten Foundation, Switzerland, and the EMDO Foundation, Switzerland. M.M. is supported by a research grant from the Iten-Kohaut Foundation, Switzerland. Funding Information: Conflict of interest: The University Hospital of Zurich holds a research contract with GE Healthcare. C.G. has received research grants from the Funding Information: Novartis Foundation, Switzerland. J.K.M. receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. J.K.M. serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. All other authors declared no conflict of interest. Publisher Copyright: {\textcopyright} 2020 Published on behalf of the European Society of Cardiology. All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",
year = "2020",
month = apr,
day = "1",
doi = "10.1093/ehjci/jez321",
language = "English",
volume = "21",
pages = "363--374",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
number = "4",
}