Prediction of All-Cause Mortality, Cardiovascular Mortality, and Angiographic Coronary Disease From LVEF Reserve: Findings From the Multicenter REFINE PET Registry

BACKGROUND: Left ventricular ejection fraction reserve (LVEF-R), defined as stress EF minus rest EF, is a marker for high-risk coronary artery disease in patients undergoing positron emission tomography myocardial perfusion imaging, but its prognostic and diagnostic significance in large real-world populations remains incompletely defined. We aimed to analyze the association of LVEF-R with mortality and high-risk obstructive coronary artery disease in a large multicenter cohort. METHODS: We analyzed 34 976 patients from 13 sites who underwent gated rest and vasodilator stress positron emission tomography myocardial perfusion imaging from the Registry of Flow and Perfusion Imaging for Artificial Intelligence with PET. Associations between LVEF-R and all-cause mortality and cardiovascular death were assessed using multivariable Cox regression models. In a subset with invasive coronary angiography (n=6843), the relationship between LVEF-R and angiographic disease was evaluated. RESULTS: <0.001). A negative LVEF-R was also associated with high-risk coronary artery disease, including left main and 3-vessel disease. CONCLUSIONS: LVEF-R is an independent predictor of mortality, with a graded association between impaired reserve and adverse outcomes. A negative LVEF-R identifies patients with a higher likelihood of multivessel or left-main coronary artery disease, supporting its role as a clinically relevant marker of high-risk disease.

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Publication Details

Journal
Circulation Cardiovascular Imaging
Published
2026-10-28
DOI
https://doi.org/10.1161/circimaging.126.020062
Primary Topic
Cardiac Imaging and Diagnostics
Type
article
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article

Prediction of All-Cause Mortality, Cardiovascular Mortality, and Angiographic Coronary Disease From LVEF Reserve: Findings From the Multicenter REFINE PET Registry

Isabel Carvajal-Juárez, Waseem Hijazi, Leandro N. Slipczuk, Aakash Dhananjay Shanbhag et al.
Circulation Cardiovascular Imaging
Cardiac Imaging and Diagnostics
article

Prediction of All-Cause Mortality, Cardiovascular Mortality, and Angiographic Coronary Disease From LVEF Reserve: Findings From the Multicenter REFINE PET Registry

Isabel Carvajal-Juárez, Waseem Hijazi, Leandro N. Slipczuk, Aakash Dhananjay Shanbhag, Mark H. Lemley, René R. Sevag Packard, Mouaz Husayn Al-Mallah, Panithaya Chareonthaitawee, Attila Fehér, Robert J.H. Miller, Samuel B. Wopperer, Andrew Jeffrey Einstein, Sharmila Dorbala, Viet T. Le, Damini Dey, Ronny R. Buechel, Paul Kavanagh, Robert A. deKemp, Jacek Kwieciński, Mark I. Travin, Wanda Acampa, Tejas Parekh, Marcelo F. Di Carli, Stacey Knight, Piotr J. Slomka, Thomas L. Rosamond, Jianhang Zhou, Daniel S. Berman, Giselle Ramirez, Steve Mason, Erick Alexanderson, Joanna X. Liang
article en

Abstract

BACKGROUND: Left ventricular ejection fraction reserve (LVEF-R), defined as stress EF minus rest EF, is a marker for high-risk coronary artery disease in patients undergoing positron emission tomography myocardial perfusion imaging, but its prognostic and diagnostic significance in large real-world populations remains incompletely defined. We aimed to analyze the association of LVEF-R with mortality and high-risk obstructive coronary artery disease in a large multicenter cohort. METHODS: We analyzed 34 976 patients from 13 sites who underwent gated rest and vasodilator stress positron emission tomography myocardial perfusion imaging from the Registry of Flow and Perfusion Imaging for Artificial Intelligence with PET. Associations between LVEF-R and all-cause mortality and cardiovascular death were assessed using multivariable Cox regression models. In a subset with invasive coronary angiography (n=6843), the relationship between LVEF-R and angiographic disease was evaluated. RESULTS: <0.001). A negative LVEF-R was also associated with high-risk coronary artery disease, including left main and 3-vessel disease. CONCLUSIONS: LVEF-R is an independent predictor of mortality, with a graded association between impaired reserve and adverse outcomes. A negative LVEF-R identifies patients with a higher likelihood of multivessel or left-main coronary artery disease, supporting its role as a clinically relevant marker of high-risk disease.

Circulation Cardiovascular Imaging
Cedars-Sinai Medical Center (US), Brigham and Women's Hospital (US), Houston Methodist (US), Albert Einstein College of Medicine (US), Mayo Clinic (US), Montefiore Medical Center (US), NewYork–Presbyterian Hospital (US), University of Ottawa (CA), University of Calgary (CA), University of Utah (US), Columbia University Irving Medical Center (US), Ronald Reagan UCLA Medical Center (US), Intermountain Medical Center (US), Yale University (US), University Hospital of Zurich (CH), VA West Los Angeles Medical Center (US), Montefiore Health System (US), Federico II University Hospital (IT), University of Kansas Medical Center (US), Institute of Cardiology (PL), Instituto Nacional de Cardiología (MX), Ottawa Heart Institute (CA), University of Naples Federico II (IT), Universidad Nacional Autónoma de México (MX)
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Openalex Percentile: Top 13%
Cardiac Imaging and Diagnostics
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