Meta-analysis
Clinical Characteristics and Outcomes in Patients With Heart Failure: Are There Thresholds and Inflection Points in Left Ventricular Ejection Fraction and Thresholds Justifying a Clinical Classification?
- Pooled patient-level analysis of randomised controlled trials
- 6 RCTs
- patient-level data
Authors' conclusion
In patients with HF, there was a LVEF threshold of around 40% to 50% where the pattern of patient characteristics changed, and event rates began to increase compared with higher LVEF values.
Study context
- Population
- Patients with heart failure (HF) across the full range of left ventricular ejection fraction (LVEF), from 6 randomised HF trials (reduced and preserved EF)
- Participants
- 33,699 patients · 6 RCTs
- Outcome
- Incidence of all-cause death (and specific causes of death) and HF hospitalization in relation to LVEF
Pooled result
As reported in the abstract
Clinical outcomes by LVEF
LVEF inflection point for all-cause death and CV death
around 50%
LVEF inflection point for pump failure death
around 40%
LVEF inflection point for HF hospitalization
around 35%
Further pooled results
Patient characteristics by LVEF
- Above LVEF 50%: age and women still increased, ischemic pathogenesis and NT-proBNP decreased; other characteristics did not change meaningfully
- >50%
- As LVEF increased: age, women, BMI, SBP, AF and DM increased; ischemic pathogenesis, eGFR and NT-proBNP decreased
Cardiac structure with high-normal LVEF (echocardiographic subset)
- No structural differences suggestive of amyloidosis; NT-proBNP consistent
Original publication
Clinical Characteristics and Outcomes in Patients With Heart Failure: Are There Thresholds and Inflection Points in Left Ventricular Ejection Fraction and Thresholds Justifying a Clinical Classification? Circulation. Published 27 June 2023. doi:10.1161/circulationaha.122.063642
Summarised from the published abstract; every number is checked against it