Distribution of left ventricular ejection fraction and heart rate values in a cohort of stable coronary patients: the INDYCE registry.
BACKGROUND
The distribution of left ventricular ejection fraction (LVEF) - a key factor in coronary artery disease (CAD) patient management and prognostication - is poorly documented.


OBJECTIVE
To determine LVEF and heart rate (HR) values, and describe the management of stable CAD patients in France.


METHODS
The INDYCE survey was a prospective, multicentre registry of consecutive stable CAD outpatients attending a cardiology consultation. The survey focused on LVEF values measured using the echocardiographic Simpson biplane method. Drug therapy, resting HR, blood pressure and symptoms were also recorded.


RESULTS
Overall, 3119 patients (68.4 +/- 11.0 years; 80% men) were enrolled. LVEF was 56.1+/-11.8% on average, and was poor (<40%) and moderately impaired (40-50%) in 9.6% (n=298) and 19.8% (n=619) of cases, respectively. Symptomatic angina pectoris was present in 19.2% of cases and only 40.6% of patients were asymptomatic (no angina and NYHA class < or = I) despite relatively aggressive management (79.0% of patients had undergone coronary angioplasty and/or bypass graft). Interestingly, 14.1% of patients with LVEF less than 40% were asymptomatic. In multivariable analysis, LVEF less than 40% was associated most strongly with symptomatic status (odds ratio 3.82; 95% CI 2.59-5.63; P<0.0001), together with female sex, age greater than 75 years, diabetes, HR greater or equal to 70 bpm, sedentariness, obesity and disease duration.


CONCLUSIONS
Only 9.6% of stable CAD patients had severe left ventricular dysfunction; among them, 14.1% were strictly asymptomatic. This could justify regular LVEF measurement in CAD patients. Three potentially reversible factors (HR>or=70 bpm, being overweight and sedentariness) were linked independently to the presence of symptoms.
Tabet
Jean-Yves
JY
Les Grands Prés, 77174 Villeneuve Saint-Denis, France. jtabet@free.fr
Malergue
Marie-Christine
MC
Guenoun
Maxime
M
Paganelli
Franck
F
Meurin
Philippe
P
Not
Didier
D
Jourdain
Patrick
P
Guedj-Meynier
Dominique
D
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left
D002317:Cardiovascular Agents