Exercise-Induced Reduction in Left Ventricular Ejection Fraction in the Absence of Coronary Artery Disease: Clinical Characteristics and Outcomes

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2025-05-01 DOI:10.1016/j.echo.2024.11.008

Luca Fazzini MD , Scott A. Hubers MD , Jenny J. Cao MB Bchir , Christopher G. Scott MS , Robert B. McCully MD , Matteo Castrichini MD , Marta Figueiral MD , Akanksha Mohananey MD , Li Wang MBBS, PhD , Rajiv Gulati MD, PhD , Roberta Montisci MD , Patricia A. Pellikka MD , Naveen L. Pereira MD

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引用次数: 0

Abstract

Background

During exercise stress echocardiography (ESE), there are patients with normal left ventricular ejection fraction (LVEF) who paradoxically develop reduced LVEF during exercise despite absence of coronary artery disease (CAD) and a significant hypertensive response. This study sought to describe the clinical features and outcomes of this population.

Methods

Among ESEs performed between 2003 and 2022, patients without CAD by angiogram within 90 days of ESE and resting LVEF ≥50% with a ≥5% LVEF decrease during ESE were included. Outcomes assessed were all-cause mortality, heart failure (HF) hospitalization, and atrial fibrillation (AF). Kaplan-Meier and Cox regression methods were used to analyze time-to-event outcomes.

Results

Among 213,643 ESE, 134 patients met the eligibility criteria. The mean age of the population was 66 ± 10 years, 76% were women, and 16% had AF at baseline. Mean LVEF was 58% ± 4% at rest and 43% ± 4% at peak stress. Stress ECG met the criteria for ischemia in 14% of these patients. The 10-year estimated incidence of HF hospitalization was 17.6% (95% CI, 9.0%-26.2%). Among the subgroup without AF at baseline, the 10-year estimated incidence of developing AF was 23.4% (95% CI, 13.4%-33.4%). The 10-year estimated incidence of all-cause mortality was 12.9% (95% CI, 5.5%-20.3%), with 89% of deaths occurring due to noncardiovascular causes.

Conclusion

Patients with exercise-induced reduction in LVEF in the absence of obstructive CAD have a high incidence of HF hospitalizations and AF. The underlying pathophysiology of this disease process needs to be further investigated.

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无冠状动脉疾病时运动诱导的左心室射血分数降低：临床特征和结果

背景：在运动应激超声心动图（ESE）中，有一些左心室射血分数（LVEF）正常的患者，尽管没有冠状动脉疾病（CAD）和明显的高血压反应，但在运动期间却出现了LVEF降低。本研究试图描述这一人群的临床特征和结果。方法：在2003年至2022年期间进行ESE的患者中，包括ESE 90天内血管造影无CAD，静息LVEF≥50%且ESE期间LVEF下降≥5%的患者。评估的结果是全因死亡率、心力衰竭（HF）住院和心房颤动（AF）。Kaplan-Meier和Cox回归方法用于分析时间到事件的结果。结果：在213643例ESE中，134例患者符合入选标准。人群的平均年龄为66±10岁，76%为女性，16%基线时患有房颤。静息时平均LVEF为58±4%，峰值时平均LVEF为43±4%。这些患者中14%的应激心电图符合缺血标准。10年心力衰竭住院的估计发生率为17.6% （95% CI 9.0-26.2）。在基线时无房颤的亚组中，10年估计发生房颤的发生率为23.4% （95% CI 13.4-33.4）。10年全因死亡率的估计发生率为12.9% (95% CI 5.5-20.3)，其中89%的死亡是由非心血管原因造成的。结论：在无阻塞性CAD的情况下，运动诱导LVEF降低的患者HF住院和房颤的发生率较高，该疾病过程的潜在病理生理学有待进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.