Abstract
BACKGROUND: Supranormal left ventricular ejection fraction (LVEF) confers a paradoxically higher mortality risk; however, whether intrinsic structural changes of left ventricle (LV) play an important role remain unclear. OBJECTIVES: The authors sought to investigate the prognostic implication of supranormal LVEF and its interaction with LV concentric remodeling. METHODS: Consecutive participants undergoing echocardiography in a tertiary medical center with LVEF >60% were included. LV concentric remodeling was defined as LV relative wall thickness >0.42. The primary outcome was all-cause mortality. The association between LVEF and all-cause mortality was assessed using Cox models and restricted cubic splines. Subgroup analysis was performed to evaluate the association between LVEF and risk of death stratified by LV concentric remodeling. RESULTS: In total, 67,108 participants (age 60.5 ± 17.2 years, men 44.6% [n = 29,924]) were included. 7,029 deaths of 67,108 (10.5%) occurred over a median of 50.3 months (Q1, Q3: 20.9, 91.3 months). In multivariable Cox models, subjects with LVEF above 70% had a significantly higher risk (vs 60%-65%) for all-cause mortality (adjusted HR: 1.15; 95% CI: 1.05-1.26; P = 0.003) after adjusting for potential confounders. A significant interaction was observed between LVEF and LV concentric remodeling (P for interaction <0.001), particularly in women, such that a higher mortality risk of supranormal LVEF could be observed mainly among those with LV concentric remodeling. CONCLUSIONS: Supranormal LVEF >70% is associated with a greater risk for all-cause mortality. The higher mortality risk could be predominantly observed among individuals presented with LV concentric remodeling, particularly in women.