Prediction of All-Cause Mortality, Cardiovascular Mortality, and Angiographic Coronary Disease From LVEF Reserve: Findings From the Multicenter REFINE PET Registry
Authors' conclusion
LVEF-R is an independent predictor of mortality, with a graded association between impaired reserve and adverse outcomes. A negative LVEF-R identifies patients with a higher likelihood of multivessel or left-main coronary artery disease, supporting its role as a clinically relevant marker of high-risk disease.
Study context
- Population
- Patients who underwent gated rest and vasodilator stress positron emission tomography myocardial perfusion imaging, from the Registry of Flow and Perfusion Imaging for Artificial Intelligence with PETpatients from 13 sites, subset with invasive coronary angiography n=6843 · Subset with invasive coronary angiography 6,843
- Participants
- 34,976 patients
- Exposure
- Association of left ventricular ejection fraction reserve (LVEF-R) (stress EF minus rest EF) with all-cause mortality, cardiovascular death and angiographic coronary disease
- Outcome
- All-cause mortality
- Follow-up
- Median 4.1 years
Methodological details13 sites
- 13 sites
Main finding
As reported in the abstract
Each group vs LVEF-R>5%Adjusted hazard ratio (95% CI)P value
LVEF-R 0% to 5%
1.20(1.13–1.28)
P < 0.001LVEF-R −5% to 0%
1.32(1.23–1.42)
P < 0.001LVEF-R ≤−5%
1.38(1.24–1.52)
P < 0.001Observational data: associations, not effects.
Further findings
High-risk coronary artery disease, including left main and 3-vessel disease
- A negative LVEF-R was associated with high-risk coronary artery disease
- Subset with invasive coronary angiography (n=6843)
LVEF-R<0%
- Patients with an LVEF-R<0%
- 9392 (26.9%)
Original publication
Prediction of All-Cause Mortality, Cardiovascular Mortality, and Angiographic Coronary Disease From LVEF Reserve: Findings From the Multicenter REFINE PET Registry. Circ Cardiovasc Imaging. Published 28 October 2026. doi:10.
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