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[Heart failure caused by severe systolic ventricular dysfunction of hypertensive origin. Long-term clinical and
M Anguita1, J C Castillo, A Ramírez
1Servicio de Cardiología, Hospital Reina Sofía, Córdoba.
Insights
Severe congestive heart failure patients showed 100% survival and improved ejection fraction over three years. Despite positive outcomes, persistent left ventricular dilatation indicates lasting myocardial damage from hypertension.
Area of Science:
- Cardiology
- Internal Medicine
- Heart Failure Research
Context:
- Dilated cardiomyopathy often leads to severe congestive heart failure (CHF).
- Hypertension is a significant contributing factor to heart failure.
- Assessing long-term outcomes in CHF patients is crucial for treatment optimization.
Purpose:
- To evaluate survival rates in patients with severe CHF due to dilated cardiomyopathy.
- To assess the evolution of functional class and ventricular function over time.
- To determine the long-term impact of treatment on severe systolic left ventricular dysfunction.
Summary:
- This study followed 17 patients with severe CHF (NYHA class III/IV, LVEF < 40%) due to dilated cardiomyopathy and hypertension.
- Patients received standard medical therapy, including ACE inhibitors, diuretics, and beta-blockers.
- Over a mean follow-up of 3.3 years, 100% survival was observed, with significant improvements in left ventricular ejection fraction (LVEF) and reduction in systolic diameter.
Impact:
- Long-term favorable outcomes, including null mortality and improved cardiac function, are achievable in severe CHF.
- Effective management of hypertension and heart failure can reverse systolic dysfunction.
- Persistent left ventricular dilatation highlights the irreversible nature of myocardial damage from chronic pressure overload.
Aims:
The aims of our study were to evaluate survival and evolution of functional class and ventricular function in patients with severe congestive heart failure due to dilated cardiomyopathy.
Methods:
Inclusion criteria were: class III or IV heart failure, dilated left ventricle with ejection fraction < 40%, history of poor controlled hypertension, and exclusion of other etiologies for heart failure. We studied 17 patients with these features; mean age was 64 +/- 7 years and 70% were male. They were followed up during a mean period of 3.3 +/- 1 years (2 to 6; median 3 years).
Results:
Baseline left ventricular ejection fraction was 30 +/- 5% (20 to 40); 35% of patients were in functional class III and 65% in class IV; 100% of patients received ACE inhibitors and diuretics, 53% betablockers, and 35% calcium-antagonists. Survival was 100%. Left ventricular ejection fraction increased from 30 +/- 5% to 44 +/- 11% at one year, to 50 +/- 11% at 3 years and 51 +/- 10% at the end of follow-up (p < 0.001). This improvement was mainly due to a reduction in systolic left ventricular diameter (from 51 +/- 4 mm to 42 +/- 11 mm, p < 0.01), since diastolic diameter did not significantly changed (63 +/- 4 to 59 +/- 11 mm).
Conclusions:
The evolution of severe systolic left ventricular dysfunction due to arterial hypertension is favourable at long-term, with null mortality and clinical ejection fraction and functional improvement. Nevertheless, the persistence of left ventricular dilatation suggests that myocardial damage caused by chronic pressure overload does not disappear.