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Long-term outcome in patients with congestive heart failure and intact systolic left ventricular performance
J F Setaro1, R Soufer, M S Remetz
1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510.
Insights
Congestive heart failure (CHF) with normal left ventricular (LV) systolic function carries a high risk of cardiovascular events. Long-term outcomes reveal significant mortality and morbidity, necessitating tailored therapeutic strategies.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Outcomes
Background:
- Congestive heart failure (CHF) is often linked to impaired left ventricular (LV) systolic function.
- Limited data exists on the long-term prognosis for patients with CHF and preserved LV systolic function.
Purpose of the Study:
- To investigate the 7-year outcomes in patients initially hospitalized with CHF and normal LV systolic function.
- To assess cardiovascular mortality and morbidity in this specific patient cohort.
Main Methods:
- A cohort of 52 patients with CHF and LV ejection fraction >= 45% was followed for 7 years.
- Data collected included baseline characteristics, cardiovascular diagnoses, and clinical events.
- Outcomes analyzed included cardiovascular mortality and nonfatal cardiovascular morbidity.
Main Results:
- At 7 years, cardiovascular mortality was 46% and noncardiovascular mortality was 10%.
- Cardiovascular morbidity occurred in 29% of patients, with a combined mortality and morbidity of 75%.
- Survival was not significantly correlated with age, diagnosis, LV ejection fraction, or diastolic dysfunction.
Conclusions:
- Preserved LV systolic function does not guarantee a favorable prognosis in patients with CHF.
- Patients with CHF and normal LV systolic function face a substantial risk of future cardiovascular events.
- Therapeutic strategies for this population require careful consideration of their high-risk profile.
Abstract:
Congestive heart failure (CHF) is typically associated with impaired left ventricular (LV) systolic performance. Few reports exist describing the long-term outcome in patients with CHF and normal LV systolic function. Fifty-two patients initially hospitalized with CHF and intact LV function (ejection fraction greater than or equal to 45%) were followed for 7 years. Mean age when initially identified was 71 +/- 11 years (range 36 to 96), and average LV ejection fraction was 61 +/- 11%. CHF was graded by a clinicoradiographic index, with a mean of 7.0 +/- 2.3 (range 3 to 12, 13 indicates worst CHF). A third heart sound was present in 19 patients (37%), and 17 (33%) had presented with acute pulmonary edema. Principal cardiovascular diagnoses were coronary artery disease in 27 (52%), hypertensive heart disease in 16 (31%) and restrictive cardiomyopathy in 7 (13%). At 7 years, cardiovascular mortality was 46% (24 of 52), and noncardiovascular mortality was 10% (5 of 52). Survival was not correlated with age, principal diagnosis, third heart sound, pulmonary edema at presentation, LV ejection fraction, or presence or degree of LV diastolic dysfunction. Cardiovascular morbidity, consisting of nonfatal recurrent CHF, myocardial infarction, unstable angina or other cardiovascular events occurred in 29% (15 of 52). Combined cardiovascular mortality and morbidity was 75% (39 of 52). In patients with CHF, intact LV systolic function does not confer the same favorable prognosis it defines in other clinical situations. For such patients, the risk of future cardiovascular events is high, a finding that should be considered when designing therapeutic strategies in this group.