The risk of death according to left ventricular ejection fraction and right ventricular dilatation in 17 321 adults with heart failure from 40 high-, middle- and low-income countries - A Global Congestive Heart Failure (G-CHF) study

Aims: The aim of this study was to describe the prognostic importance of left ventricular ejection fraction (LVEF) versus right ventricular (RV) dilatation and dysfunction in patients with heart failure (HF) from countries of different income levels.

Methods and results: We enrolled 17 321 participants with HF from 40 countries. Participants were followed for a median (25th-75th percentile) of 2.1 (2.0-4.6) years. Cox proportional hazards models were performed with adjustment for age, sex, HF aetiology, diabetes, atrial fibrillation, chronic obstructive pulmonary disease, tobacco and alcohol use, functional class, and the use of HF medications, blood pressure, serum creatinine and HF duration. During follow-up, 5738 (33%) participants died and 3569 (21%) were hospitalized for HF. Compared with LVEF ≥50%, the hazard ratios (HR) for death were 0.88 (95% confidence interval [CI] 0.80-0.97, p = 0.009) in patients with LVEF 40-49%, 0.96 (95% CI 0.88-1.05, p = 0.40) for LVEF 30-39%, and 1.18 (95% CI 1.08-1.29, p < 0.0001) for LVEF <30%. RV enlargement was associated with an increased risk of death (HR 1.35, 95% CI 1.26-1.44, p < 0.0001). The relationship between LVEF and death differed according to HF aetiology (interaction p = 0.0010). In ischaemic HF and idiopathic dilated cardiomyopathy, there was a continuous inverse association between LVEF and the risk of death, but in hypertensive, valvular and other HF types, there was no association between LVEF and the risk of mortality.

Conclusion: Reduced LVEF was associated with worse prognosis in ischaemic and idiopathic dilated cardiomyopathy but not in HF of other causes. RV enlargement was associated with a more marked increase in the risk of death.