Left ventricular systolic function may be altered in patients with coronary artery disease with or without previous myocardial infarction (MI). However, whether left ventricular ejection fraction (LVEF) is reduced (<50%) in patients with stable coronary artery disease with normal electrocardiogram (ECG) is poorly documented.

Echocardiography was performed in the 3119 patients with stable coronary artery disease included in the prospective multicenter INDYCE registry; 875 patients (28%) had a normal ECG. These patients (66 ± 10 years old, male: 79%, BMI: 26 ± 3) had a mean LVEF = 62 ± 8% (<40%: 1%, 40%<LVEF<50%: 8%, >50%: 91% of the patients). Twenty six percent of them had a previous MI. Eighty four percent of them had undergone coronary revascularisation (CABG: 20% and PCA: 68%), 19% had diabetes, 80% dyslipidemia and 56% high blood pressure; 3% of the patients had been hospitalized for acute heart failure (HF) in the previous year; 39% were symptomatic for dyspnea NYHA class 2 or 3, 14% for angina pectoris. Sixty nine percent of them received betablockers.

BMI (p = 0.01), male gender (p = 0.01), dyspnea NYHA class 2–3 (p<0.0001) and hospitalization for HF in the previous year (p = 0.01) were significantly associated with LV systolic dysfunction in univariate analysis. In multiple logistic regression including all parameters with a p value <0.05 in univariate analysis, male gender (chi-2 = 9,1, p = 0.002), NYHA class 2–3 (chi-2 = 6.2, p = 0.01) and BMI (chi-2 = 6.6, p = 0.01) were independently associated with LV systolic dysfunction. Previous MI, HF decompensation, revascularisation, presence of angina pectoris were not significantly associated with LV systolic dysfunction.

LV systolic function is significantly altered in 9% of patients with stable coronary artery disease with normal ECG in INDYCE registry. Male gender, NYHA class 2–3 and BMI seem to be independently associated with LV systolic dysfunction in this population.