Predictors of prognosis in severe chronic heart failure

doi:10.1016/0002-8703(92)90656-G

American Heart Journal

Volume 123, Issue 2, February 1992, Pages 421-426

https://doi.org/10.1016/0002-8703(92)90656-G Get rights and content

Abstract

A total of 127 patients with chronic heart failure referred to our exercise laboratory were studied retrospectively to identify parameters predictive of prognosis. Patients were followed for a mean of 14.6 months. The group as a whole had severe ventricular dysfunctin with a median ejection traction of 17% and a median peak rate of oxygen consumption of 13.7 ml/kg/min. During the follow-up period 23 patients (18%) died and 18 (14%) underwent cardiac transplantation. The effect of the following variables on outcome (death or transplantation) were examined: age, cause of heart failure, cardiothoracic ratio on chest radiography, left ventricular end-systolic dimension on echocardiography, left ventricular ejection fraction on radionuclide ventriculography, mean dose of diuretic, plasma sodium and urea concentrations, and peak oxygen consumption during exercise. Although all variables except cause of heart faillre affected outcome on univariate analysis, multivariate analysis identified three varlables that were statistically significant and independent predictors of outcome. In order of importance these were plasma sodium level, left ventricular ejection fraction and peak oxygen consumption. Even in this group of patients with severe heart failure, these variables were predictive of outcome.

References (32)

JA Franciosa et al.
Survival in men with severe heart failure due to either coronary heart disease or idiopathic dilated cardiomyopathy
Am J Cardiol
(1983)
N Davies et al.
Measurement of metabolic gas exchange and minute volume by mass spectrometry alone
Respir Physiol
(1979)
DV Unverferth et al.
Factors influencing the one year mortality of dilated cardiomyopathy
Am J Cardiol
(1984)
JR Wilson et al.
Prognosis in severe heart failure: relation to hemodynamic measurements and ventricular ectopic activity
J Am Coll Cardiol
(1983)
JJ Brown et al.
Renin relationships in congestive cardiac failure, treated and untreated
Am Heart J
(1970)
TL Kelly et al.
Prediction of outcome in late-stage cardiomyopathy
Am Heart J
(1990)
JA Franciosa et al.
Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure
Am J Cardiol
(1981)
R Engler et al.
Clinical assessment and follow-up of functional capacity in patients with chronic congestive cardiomyopathy
Am J Cardiol
(1982)
V Fuster et al.
The natural history of idiopathic dilated cardiomyopathy
Am J Cardiol
(1981)
BJ Baker et al.
Predictive value of M-mode echocardiography in patients with congestive heart failure
Am Heart J
(1986)

JN Cohn et al.

Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration cooperative study

N Engl J Med

(1986)

Effects of enalapril on mortality in severe congestive heart failure

N Engl J Med

(1987)

DP Lipkin et al.

Respiratory gas exchange in the assessment of patients with impaired ventricular function

Br Heart J

(1985)

CR Rao

Linear statistical inference and its application

(1973)

RA Diaz et al.

Prediction of outcome in dilated cardiomyopathy

Br Heart J

(1987)

JGF Cleland et al.

Mortality in heart failure: clinical variables of prognostic value

Br Heart J

(1987)

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Myocardial performance index (MPI) is an echocardiographic parameter that reflects left ventricular (LV) function. MPI determined by means of tissue Doppler imaging (TDI) at different LV sites (global MPI) and its long-term prognostic implications in congestive heart failure (HF) have not been evaluated.
A total of 110 patients with HF during acute hospitalization were followed for a mean of 5.0 years for survivors. The myocardial velocities at 4 different LV sites near the mitral annulus from apical views were recorded with the use of pulsed-wave TDI. From myocardial velocity profiles, the MPI at each LV site was calculated: MPI = (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. The global MPI was calculated as the mean from the 4 LV sites. Mean ejection fraction was 25%. A total of 61 patients died during the study period. On multivariate analysis, only MPI emerged as an independent predictor of mortality. With a cutoff value of 0.67, the hazard ratio for cardiovascular mortality during the follow-up period was 13 (95% confidence interval 5.03–34.44; P < .001). A cutoff MPI value of ≥0.67 identified patient mortality during the study period with a sensitivity of 86% and a specificity of 79%.
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2010, Archives of Cardiovascular Diseases
The minute ventilation/carbon dioxide production (VE/VCO₂) slope and peak circulatory power, like peak oxygen consumption (VO₂), possess strong prognostic values in heart failure but have not been studied after ventricular resynchronization.
In this retrospective study, we evaluated the evolution of ventilatory response, effort capacity, functional status, peak circulatory power and echocardiographic variables, 6 months after cardiac resynchronization therapy (CRT).
Thirty subjects (mean age, 60 ± 12 years) underwent symptom-limited exercise testing (CPX) with ventilatory expired gas analysis before and 6 months after CRT. The VE/VCO₂ slope was measured from rest to the end of exercise. Echocardiography was performed in stable clinical and pharmacological conditions.
Mean New York Heart Association (NYHA) status improved significantly from 2.9 to 1.8 (p < 0.001). Significant improvements were seen in exercise tolerance (evaluated by peak VO₂; from 13.1 ± 3.1 to 15.3 ± 5.6 mL/kg/min, p = 0.02), VE/VCO₂ slope (from 44.4 ± 19.2 to 39.6 ± 13.8, p = 0.003) and maximal workload (from 74 ± 24 to 82 ± 26 W, p = 0.02). Mean peak circulatory power improved from 1663 ± 494 to 2125 ± 1014 mmHg mL/kg/min (p = 0.009). Mean left ventricular ejection fraction increased from 25% to 29% (p = 0.01). Mean end-systolic and end-diastolic left ventricular volumes decreased significantly from 155 to 128 mL and from 203 to 179 mL, respectively (p < 0.05). Mean mitral regurgitation grade improved from 1.4 ± 1.0 to 1.1 ± 0.9 (p = 0.1). No strong correlation was found between echocardiographic changes and improvement in ventilatory efficiency (VE/VCO₂ slope; all r = 0.15–0.24). Patients with narrow QRS complexes (< 130 ms) did not show significant improvement in functional or echocardiographic variables other than NYHA status.
Cardiac resynchronization therapy improved ventilatory and haemodynamic responses. Our results highlight the potential value of new functional variables such as ventilatory response and peak circulatory power as better markers for identifying responders to CRT.
L’étude de la réponse ventilatoire par la pente de régression linéaire de la ventilation minute et de la production de dioxyde de carbone (VE/VCO₂) et la mesure de la puissance circulatoire au cours d’une épreuve d’effort possède une valeur pronostique significative chez l’insuffisant cardiaque. L’évolution de la réponse ventilatoire n’a pas été étudiée après resynchronisation biventriculaire.
L’objectif principal était d’étudier l’évolution de la réponse ventilatoire, de la puissance circulatoire au pic et des paramètres échocardiographiques après resynchronisation biventriculaire.
Trente patients (âge moyen : 60 ± 12 ans) ayant bénéficié d’une épreuve d’effort avec mesure des échanges gazeux ainsi que d’une échocardiographie transthoracique avant et six mois après implantation ont été inclus. La réponse ventilatoire était évaluée par la pente de régression linéaire de VE/VCO₂ en incluant l’ensemble des points du début à la fin de l’exercice. Une valeur ponctuelle de VE/VCO₂ était mesurée au pic de l’exercice. La classe New York Heart Association (NYHA) était améliorée de 2,9 à 1,8 (p < 0,001). Le pic de VO₂, la pente de régression de VE/VCO₂ et la charge maximale au pic de l’exercice étaient significativement améliorés après resynchronisation, de 13 ± 3 à 15 ± 5 mL/kg par minute, de 44 ± 19 à 39 ± 13 (p = 0,02) et de 74 ± 24 à 82 ± 26 W (p = 0,02) respectivement. La puissance circulatoire était augmentée de 1663 ± 494 à 2125 ± 1014 mmHg ml/kg par minute (p = 0,009). La fraction d’éjection ventriculaire gauche s’est améliorée de 25 % à 29 % (p = 0,01), ainsi que le volume télésystolique (155 à 128 mL ; p = 0,002) et télédiastolique (203 à 179 mL ; p = 0,004). L‘insuffisance mitrale était néanmoins améliorée de manière non significative (1,4 ± 1 à 1,1 ± 0,9 ; p = 0,1). Néanmoins, il n’a pas été retrouvé de corrélation significative entre l’amélioration de la réponse ventilatoire et celle des volumes ventriculaires gauches après resynchronisation (valeur de r entre 0,15 et 0,24). Enfin, les patients présentant des QRS fins (< 130 ms) ne présentaient aucune amélioration fonctionnelle objective ni échocardiographique à l’exception de la classe NYHA.
La resynchronisation biventriculaire améliore la réponse ventilatoire et hémodynamique. Nos résultats soulignent l’importance de l’étude de la réponse ventilatoire et de la puissance circulatoire comme marqueurs fonctionnels de réponse après resynchronisation biventriculaire.
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Predictors of prognosis in severe chronic heart failure

Abstract

Am J Cardiol

Respir Physiol

Am J Cardiol

J Am Coll Cardiol

Am Heart J

Am Heart J

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration cooperative study

N Engl J Med

Effects of enalapril on mortality in severe congestive heart failure

N Engl J Med

Respiratory gas exchange in the assessment of patients with impaired ventricular function

Br Heart J

Linear statistical inference and its application

Prediction of outcome in dilated cardiomyopathy

Br Heart J

Mortality in heart failure: clinical variables of prognostic value

Br Heart J