An elevated cardiovascular disease (CVD) risk has been linked to echocardiographic evidence of a supranormal ejection fraction in patient populations referred for clinical care. Supranormal left ventricular ejection fraction (LVEF), as measured by cardiac magnetic resonance (CMR) in otherwise healthy people living in the community, has unclear prognostic implications. The study aimed to examine the correlation between stroke volume and CMR-assessed LVEF to determine the predictive significance of LVEF in persons free of CVD living in the community. Those without CVD who had a CMR performed and had an LVEF greater than the standard CMR cutoff (≥57%) were included in the MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) cohorts. The association between cohort-specific LVEF categories and risk of clinically adjudicated major adverse cardiovascular events (MACE) was assessed using adjusted Cox models. Individuals were also divided into subgroups based on their left ventricular stroke volume index to determine if there was a correlation between LVEF and risk of MACE. The study included 4,703 participants from MESA and 2,287 from DHS, with 727 and 151 MACE events, respectively. Individuals in LVEF Q4 (vs. Q1) had a higher risk of MACE in both cohorts after controlling for possible confounders (adjusted Cox models: MESA: HR=1.27 [95% CI: 1.01-1.60], P=0.04; DHS: HR=1.72 [95% CI: 1.05-2.79], P=0.03). Greater LVEF was substantially related to an elevated risk of MACE among those with low but not high stroke volume (P interaction=0.02), suggesting that the two consecutive measures of LVEF and left ventricular stroke volume index interact considerably. Supranormal LVEF is related to an increased risk of poor cardiovascular events, especially in persons in the community who do not have CVD and have a smaller stroke volume.
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