Change in Ejection Fraction and Long-Term Mortality in Adults Referred for Echocardiography.

AIMS We investigated long-term mortality associated with changes in left ventricular ejection fraction (LVEF) in a large, real-world patient cohort. METHODS AND RESULTS 117 275 adults (46% women, 63 ± 16 years) had LVEF quantified by the same method ≥6 months apart. This included 17 343 cases (48% women, 66 ± 15 years) being initially investigated for heart failure (HF). During 3.3 (IQR 1.7 to 6.0) years from first-to-last echocardiogram, median change in LVEF was -1 (IQR -8 to +5) units from a baseline of 62% (IQR 54% to 69%). During subsequent 7.6 (IQR 4.3 to 10.1) years follow-up, 11 397 (9.7%) and 34 101 (29.1%) cases died from cardiovascular disease and all-causes, respectively. Actual 5-year, all-cause mortality increased from 12% to 29% among those with the smallest to the largest decrease in LVEF (from 50 units); the adjusted risk of cardiovascular-related mortality increased 2- to 8-fold beyond a > 10-unit decline in LVEF (versus minimal change; p   30-unit increase to >30-unit decline in LVEF (versus minimal change; p < 0.001 for both comparisons). A distinctive, bi-directional plateau of improved versus worsening mortality was evident around a final LVEF of 50% to 55%. CONCLUSIONS These data, derived from a large, heterogeneous cohort of adults being followed-up with echocardiography, suggest that modest LVEF changes (particularly around an LVEF of 50% to 55%) may be of clinical significance. This article is protected by copyright. All rights reserved.