Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction - Prevalence and mortality in a population-based cohort

OBJECTIVES The purpose of this study was to assess the relative proportions of normal versus impaired left ventricular (LV) systolic function among pe rsons with congestive heart failure (CHF) in the community and to compare t heir 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 preva lence and prognosis of CHF with normal LV systolic function in the communit y are not known. METHODS We evaluated the echocardiograms of 73 Framingham Heart Study subje cts 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 redu ced LVEF. Women predominated in the former group (65%), whereas men constit uted 75% or the latter group. During a median follow-up of 6.2 years, CHF c ases with normal LVEF experienced an annual mortality of 8.7% versus 3.0% f or matched control subjects (adjusted hazards ratio = 4.06, 95% confidence interval 1.61 to 10.26). Congestive heart failure cases with reduced LVEF h ad an annual mortality of 18.9% versus 4.1% for matched control subjects (a djusted 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 in more common in women than in men. Although CHF c ases with normal LVEF have a lower mortality risk than cases with reduced L VEF, they have a fourfold mortality risk compared with control subjects who are free of CHF. 1999 by the American College of Cardiology.