Heart failure & cardiomyopathies
Temporal trends in left ventricular ejection fraction before sudden death in patients with heart failure
Authors' conclusion
LVEF category changed significantly over time, resulting in substantial reclassification of risk before the SCD event. These findings highlight the major limitation of using LVEF measured at a single time point as the main predictor of SCD risk.
Study context
- Population
- Patients who experienced sudden cardiac death (SCD) after an established diagnosis of heart failure (HF) and underwent ≥2 echocardiographic evaluations performed at least 6 months apart, in Oregon and California
- Participants
- 526 vs 191
- Exposure
- Left ventricular ejection fraction (LVEF) category at first assessment vs final assessment before SCD
- Oregon discovery cohortn = 526
- California validation cohortn = 191
- Outcome
- Reclassification from LVEF of ≤35% on first assessment to LVEF of >35% at final assessment (discovery cohort)
Methodological detailsdiscovery and validation, population-based
- Discovery and validation
- Population-based
Main finding
As reported in the abstract
Patients with LVEF of ≤35% on first assessment reclassified to LVEF of >35% at final assessment
45%
Observational data: associations, not effects.
Further findings
Reclassification among patients with LVEF of 36%-49% to either ≤35% or >50% (discovery cohort)
- Patients with LVEF of 36%-49% reclassified to either ≤35% or >50%
- 66%
- P < .001
Reclassification among patients with LVEF of >50% to LVEF of <50% (discovery cohort)
- Patients with LVEF of >50% reclassified to LVEF of <50%
- 32%
- P < .001
Overall reclassification based on LVEF (discovery cohort)
- Patients in the discovery cohort reclassified based on LVEF
- 41.1%
- P < .001
Characteristics of patients with initial LVEF of ≤35% who improved vs did not
- No distinguishing characteristics were identified
Validation cohort
- Similar findings were observed in the validation cohort
Original publication
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