Prognosis of Adults With Borderline Left Ventricular Ejection Fraction

Connie W. Tsao, Asya Lyass, Martin G. Larson, Susan Cheng, Carolyn S.P. Lam, Jayashri R. Aragam, Emelia J. Benjamin, Ramachandran S. Vasan

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Objectives: 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. Background: 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. Methods: 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). Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)502-510
Number of pages9
JournalJACC: Heart Failure
Issue number6
StatePublished - Jun 1 2016
Externally publishedYes


  • Echocardiography
  • Epidemiology
  • Heart failure
  • Left ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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