Distribution of left ventricular ejection fraction and heart rate values in a cohort of stable coronary patients: The INDYCE registry

Abstract

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 ≤ 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. Conclusion: 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 ≥ 70 bpm, being overweight and sedentariness) were linked independently to the presence of symptoms. © 2010 Elsevier Masson SAS.