BACKGROUND: Left ventricular (LV) dysfunction and remodeling are key pathophysiological features underlying disease progression in chronic heart failure (CHF). HYPOTHESIS: To describe the course of LV dysfunction and identify predictors and prognostic impact of changes in LV volumes and function in stable CHF patients under optimal therapy. METHODS: There were 318 consecutive CHF outpatients who underwent a repeated echocardiographic evaluation at baseline and at 1 year and subsequently followed-up for at least 12 months. The end point of the study was all-cause mortality. RESULTS: Mean LV ejection fraction (LVEF) was 33 ± 7\% at baseline and 36 ± 9\% at follow-up. Twenty-four percent of patients had an improvement of LVEF >5 absolute points (group 1); 58\% remained stable (group 2), 17\% worsened at >5 absolute points (group 3). Age, New York Heart Association class, diuretic dose, renal function, and baseline LVEF were independent predictors of LVEF improvement at 1 year. At the Cox analysis, patients in group 3 had a 4-fold higher risk of death when compared with group 1 (hazard ratio: 3.99, 95\% confidence interval: 1.6-9.9, P = 0.002), independently of age, etiology, and symptoms severity. CONCLUSIONS: In stable CHF outpatients, LV function improves in 24\% of cases; a modest decrease in LV systolic function is associated with a significantly higher risk of all-cause mortality, independent of other markers of disease severity. Clin. Cardiol. 2012 doi: 10.1002/clc.22024 The authors have no funding, financial relationships, or conflicts of interest to disclose.
Identification of High-Risk Chronic Heart Failure Patients in Clinical Practice: Role of Changes in Left Ventricular Function.
CICOIRA, Mariantonietta;VASSANELLI, Corrado
2012-01-01
Abstract
BACKGROUND: Left ventricular (LV) dysfunction and remodeling are key pathophysiological features underlying disease progression in chronic heart failure (CHF). HYPOTHESIS: To describe the course of LV dysfunction and identify predictors and prognostic impact of changes in LV volumes and function in stable CHF patients under optimal therapy. METHODS: There were 318 consecutive CHF outpatients who underwent a repeated echocardiographic evaluation at baseline and at 1 year and subsequently followed-up for at least 12 months. The end point of the study was all-cause mortality. RESULTS: Mean LV ejection fraction (LVEF) was 33 ± 7\% at baseline and 36 ± 9\% at follow-up. Twenty-four percent of patients had an improvement of LVEF >5 absolute points (group 1); 58\% remained stable (group 2), 17\% worsened at >5 absolute points (group 3). Age, New York Heart Association class, diuretic dose, renal function, and baseline LVEF were independent predictors of LVEF improvement at 1 year. At the Cox analysis, patients in group 3 had a 4-fold higher risk of death when compared with group 1 (hazard ratio: 3.99, 95\% confidence interval: 1.6-9.9, P = 0.002), independently of age, etiology, and symptoms severity. CONCLUSIONS: In stable CHF outpatients, LV function improves in 24\% of cases; a modest decrease in LV systolic function is associated with a significantly higher risk of all-cause mortality, independent of other markers of disease severity. Clin. Cardiol. 2012 doi: 10.1002/clc.22024 The authors have no funding, financial relationships, or conflicts of interest to disclose.
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