title: Prognosis of Adults With Borderline Left Ventricular Ejection Fraction.
abstract: This study sought to examine the association of a borderline left ventricular ejection fraction (LVEF) of 50% to 55% with cardiovascular morbidity and mortality in a community-based cohort.
  
  
  
  Guidelines stipulate a LVEF >55% as normal, but the optimal threshold, if any, remains uncertain. The prognosis of a "borderline" LVEF, 50% to 55%, is unknown.
  
  
  
  This study evaluated Framingham Heart Study participants who underwent echocardiography between 1979 and 2008 (n = 10,270 person-observations, mean age 60 years, 57% women). Using pooled data with up to 12 years of follow-up and multivariable Cox regression, we evaluated the associations of borderline LVEF and continuous LVEF with the risk of developing a composite outcome (heart failure [HF] or death; primary outcome) and incident HF (secondary outcome).
  
  
  
  During follow-up (median 7.9 years), HF developed in 355 participants, and 1,070 died. Among participants with an LVEF of 50% to 55% (prevalence 3.5%), rates of the composite outcome and HF were 0.24 and 0.13 per 10 years of follow-up, respectively, versus 0.16 and 0.05 in participants having a normal LVEF. In multivariable-adjusted analyses, LVEF of 50% to 55% was associated with increased risk of the composite outcome (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.05 to 1.80) and HF (HR: 2.15; 95% CI: 1.41 to 3.28). There was a linear inverse relationship of continuous LVEF with the composite outcome (HR per 5 LVEF% decrement: 1.12; 95% CI: 1.07 to 1.16) and HF (HR per 5 LVEF% decrement: 1.23; 95% CI: 1.15 to 1.32).
  
  
  
  Persons with an LVEF of 50% to 55% in the community have greater risk for morbidity and mortality relative to persons with an LVEF >55%. Additional studies are warranted to elucidate the optimal management of these individuals.
authors.affiliation: Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts. Electronic address: ctsao1@bidmc.harvard.edu.
authors.forename: Connie W
authors.initials: CW
authors.lastname: Tsao
authors.affiliation: Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.
authors.forename: Asya
authors.initials: A
authors.lastname: Lyass
authors.affiliation: Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.affiliation: Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Division of Cardiology, National University Health Centre, Singapore.
authors.forename: Carolyn S P
authors.initials: CS
authors.lastname: Lam
authors.affiliation: Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Division of Cardiology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
authors.forename: Jayashri R
authors.initials: JR
authors.lastname: Aragam
authors.affiliation: Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Sections of Cardiology and Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Division of Cardiology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Sections of Cardiology and Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000503:physiopathology
keywords: echocardiography; epidemiology; heart failure; left ventricular function