CLINICAL STUDIES
Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction
Prevalence and mortality in a population-based cohort
Ramachandran S. Vasan, MD, FACC*  ,1,
Martin G. Larson, ScD* ,
Emelia J. Benjamin, MD, ScM, FACC*  ,
Jane C. Evans, MPH* ,
Craig K. Reiss, MD, FACC|| and
Daniel Levy, MD, FACC*  ¶
* National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
Division of Cardiology and Division of Clinical Epidemiology, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts, USA
Cardiology Section, Boston Medical Center, Boston, Massachusetts, USA
Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA
|| Barnes Hospital, St. Louis, Missouri, USA
¶ National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
Manuscript received November 3, 1998;
revised manuscript received January 21, 1999,
accepted February 10, 1999.
Reprint requests and correspondence: Dr. Daniel Levy, Framingham Heart Study, 5 Thurber Street, Framingham, Massachusetts 01702
dan{at}fram.nhlbi.nih.gov
OBJECTIVES
The purpose of this study was to assess the relative proportions of normal versus impaired left ventricular (LV) systolic function among persons with congestive heart failure (CHF) in the community and to compare their long-term mortality during follow-up.
BACKGROUND
Several hospital-based investigations have reported that a high proportion of subjects with CHF have normal LV systolic function. The prevalence and prognosis of CHF with normal LV systolic function in the community are not known.
METHODS
We evaluated the echocardiograms of 73 Framingham Heart Study subjects with CHF (33 women, 40 men, mean age 73 years) and 146 age- and gender-matched control subjects (nested case–control study). Impaired LV systolic function was defined as an LV ejection fraction (LVEF) <0.50.
RESULTS
Thirty-seven CHF cases (51%) had a normal LVEF; 36 (49%) had a reduced LVEF. Women predominated in the former group (65%), whereas men constituted 75% of the latter group. During a median follow-up of 6.2 years, CHF cases with normal LVEF experienced an annual mortality of 8.7% versus 3.0% for matched control subjects (adjusted hazards ratio = 4.06, 95% confidence interval 1.61 to 10.26). Congestive heart failure cases with reduced LVEF had an annual mortality of 18.9% versus 4.1% for matched control subjects (adjusted hazards ratio = 4.31, 95% confidence interval 1.98 to 9.36).
CONCLUSIONS
Normal LV systolic function is often found in persons with CHF in the community and is more common in women than in men. Although CHF cases with normal LVEF have a lower mortality risk than cases with reduced LVEF, they have a fourfold mortality risk compared with control subjects who are free of CHF.
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Abbreviations and Acronyms
| | CHF | = congestive heart failure | | CI | = confidence interval | | LVEF | = left ventricular ejection fraction |
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