EF in low-normal range may increase HF hospitalization risk in Black patients
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Low-normal ejection fraction in Black participants was linked to an increased risk for incident HF hospitalization compared with those with normal EF, researchers found.
The study published in The American Journal of Cardiology also found that patients with low-normal EF who developed HF most often were diagnosed with HF with reduced ejection fraction.
“In the clinical setting, patients with low-normal EF are frequently encountered and often paid little attention due to being within the ‘normal’ range of EF,” Daisuke Kamimura, MD, PhD, assistant professor in the department of medical science and cardiorenal medicine at Yokohama City University Graduate School of Medicine in Japan, and colleagues wrote. “However, our results suggest that patients with low-normal EF may be in a unique category with higher HF risk and warrant further attention.”
Researchers analyzed data from 3,669 participants (mean age, 54 years; 63% women) from the Jackson Heart Study without CHD or HF at the first visit. Participants were categorized as having reduced EF (< 50%; n = 156; mean age, 54 years; 37% women), low-normal EF ( 50%; n = 367; mean age, 54 years; 54% women) and normal EF ( 55%; n = 3,146; mean age, 54 years; 66% women).
The primary outcome was first HF hospitalization.
During a median follow-up of 10 years, 197 incident HF hospitalizations occurred at an incidence rate of 8.25 per 1,000 person-years.
Participants with low-normal EF had a higher rate of HF hospitalization compared with those with normal EF after adjusting for conventional risk factors and incident CHD (HR = 1.58; 95% CI, 1.04-2.38). This association continued to be statistically significant after further adjustment for left ventricular mass index, although this was not observed when adjusting for LV diastolic dysfunction grade.
Of the patients with low-normal EF, 63% developed HFrEF and 37% were diagnosed with HF with preserved EF.
“Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and beta-adrenergic receptor blockers are well-established medications for HFrEF,” Kamimura and colleagues wrote. “Therefore, further investigation is warranted to determine whether these treatments are effective or not for this group. Importantly, these findings suggest that HF is a dynamic syndrome and that low-normal EF, while ‘normal,’ may precede a drop in EF and HFrEF.”
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