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

Summary 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.