Traditionally, doctors have known that a low LVEF is most often due to heart failure and suggests a poor prognosis. Most physicians consider LVEF above 50 percent as being normal based on guidelines published by the American Heart Association (AHA). However, Geisinger researchers led by Brandon Fornwalt, M.D., Ph.D. discovered that the mortality risk for patients with LVEF above 70 percent is similar to that of patients with LVEF of 35 to 40 percent, which is indicative of severe heart failure. In collaboration with a leading heart failure specialist, Dr. John Cleland at Imperial College London, the researchers concluded that this new finding will ultimately have a significant impact on clinical care.
“These findings suggest that we may need to begin recognizing an entirely new type of heart disease characterized by patients with a supra-normal LVEF,” said Dr. Fornwalt, the co-director of the Cardiac Imaging Technology Laboratory at Geisinger. “This research shows that careful analysis of electronic health record datasets from large clinical populations is going to reveal new findings that challenge clinical dogma and demand attention both in the clinic and in future research studies.”
This work was funded in part by the National Institutes of Health (NIH), the Pennsylvania Department of Health and Geisinger. The analysis included more than 203,000 patients cared for at Geisinger over a 20-year period spanning 1998 to 2018. These patients most commonly presented for evaluation of chest pain, shortness of breath or fatigue, coronary artery disease, aortic valve disease, and congestive heart failure.
While this work has importance for all patients who undergo imaging to assess heart function, it is particularly important for patients with heart failure since current clinical guidelines from the AHA place LVEF results for these patients into three categories: normal, borderline and reduced. This latest research reveals a potentially new category of patients with heart failure and a “supra-normal” LVEF that carries a nearly identical mortality risk to those categorized as heart failure with “reduced” LVEF.
"We believe this is the first large scale analysis of the relationship between mortality and routinely reported clinical measurements of the left ventricular ejection fraction, which is one of the most important metrics that physicians rely on to make treatment decisions across all medical specialties," Dr. Fornwalt said. “We are excited to see how these findings ultimately impact future clinical care at Geisinger and beyond."
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