Higher sex-specific LVEF may mean better outcomes in women with suspected ischemia
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Key takeaways:
- In women with suspected ischemia, those with a high left ventricular ejection fraction have reduced risk for death and heart attack.
- Female-specific LVEF strata may improve heart care in women.
Among women with suspected ischemia, using sex-specific left ventricular ejection fraction stratification, those with LVEF greater than 65% had the lowest rates of death and nonfatal MI, according to new data from the WISE study.
“Although women are known to have a relatively higher LVEF compared with men, a sex-neutral LVEF threshold continues to be used for clinical management,” Stephanie Wu, MD, cardiologist and clinical assistant professor at City of Hope, who was chief cardiology fellow at Cedars-Sinai when the study was conducted, and colleagues wrote. “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 in women presenting with suspected myocardial ischemia.”
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Wu and colleagues analyzed 734 women with suspected ischemia from the WISE study to determine whether there was a relationship between sex-specific LVEF strata and clinical outcomes. Mean ages were as follows: 61 years in the low LVEF group, 56 years in the normal LVEF group and 59 years in the high LVEF group.
Compared with high and normal LVEF, low LVEF was associated with higher rates of all-cause death and major adverse CV events (P < .0001), according to the researchers.
However, compared with high LVEF, normal LVEF was associated with higher rates of mortality (P = .047) and MI (P = .03), Wu and colleagues found.
In a multivariable regression model, low LVEF predicted mortality compared with high LVEF (P = .013) and normal LVEF trended toward predicting mortality compared with high LVEF (P = .16), the researchers wrote.
“Focusing on a female-specific approach for the recognition, diagnosis and risk assessment of CV disease will lead to more optimal management and initiation of therapeutics,” Wu and colleagues wrote. “Current guidelines do not address female-specific differences in management of heart disease and there remains a deficit of large studies focusing on women to establish reference standards. Further investigation is needed to confirm optimal female-specific LVEF in order to most effectively improve heart health with preventive and treatment strategies in women.”
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