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[Prognostic value of serial measurements of left ventricular function and exercise performance in chronic heart
Antonella Moreo1, Benedetta de Chiara, Gabriella Cataldo
1Cardiology Department, Niguarda Ca'Granda Hospital, Milán, Italia. amoreo@tin.it
Insights
Serial changes in ejection fraction, not exercise tests, predict outcomes in chronic heart failure patients. Tracking ejection fraction (EF) changes improves prognostic accuracy over baseline EF alone.
Area of Science:
- Cardiology
- Heart Failure Research
- Clinical Prognostics
Background:
- Ejection fraction (EF) and peak oxygen uptake are established prognostic markers in chronic heart failure (CHF).
- Limited data exists on the prognostic significance of serial changes in these parameters.
Purpose of the Study:
- To evaluate the prognostic value of serial changes in ejection fraction and exercise performance.
- To compare the predictive power of baseline versus serial measurements in moderate to severe CHF.
Main Methods:
- 182 CHF patients (EF <45%) underwent echocardiography and cardiopulmonary exercise testing at baseline and 10 months.
- Follow-up for cardiac death and heart transplantation over a median of 21 months.
Main Results:
- Baseline EF and change in EF (delta EF) were independently associated with adverse outcomes.
- Delta EF significantly improved the prognostic model when added to baseline EF.
- Serial cardiopulmonary exercise testing did not yield significant prognostic value.
Conclusions:
- Ejection fraction and its serial changes are independent predictors of outcome in stable CHF patients.
- Combining baseline and changes in EF offers superior prognostic performance compared to baseline EF alone.
- Serial exercise testing provides limited prognostic information in this cohort.
Introduction And Objectives:
The prognostic value of a single measurement of ejection fraction and peak oxygen uptake in chronic heart failure has been extensively investigated. The aim of our study was to evaluate the prognostic significance of serial changes in ejection fraction and exercise performance in moderate to severe chronic heart failure.
Methods:
182 patients (156 men, 53 [47-58] years) underwent echocardiography and cardiopulmonary exercise testing at baseline and after 10 [8-12] months. Most patients had idiopathic dilated cardiomyopathy (69%) and all patients presented left ventricular ejection fraction <45%. Median follow-up was 21 [14-34] months; cardiac death and heart transplantation were the end-points. Hazard ratio (HR, per unit) is presented with its 95% confidence interval (CI).
Results:
During follow-up 18 patients (9.9%) died and 14 (7.7%) underwent heart transplantation. Baseline ejection fraction (HR, 0.94, 95% CI, 0.89-0.98 P=.006) and mitral regurgitation (HR, 4.22, 95% CI, 1.63-10.92, P=.003), and delta (second examination-baseline) ejection fraction (HR, 0.93, 95% CI, 0.88-0.98, P=.01) were the only significant variables at univariate analysis. Both ejection fraction and delta ejection fraction remained independently associated with events at multivariate analysis. The prognostic power significantly increased between a model including ejection fraction alone and another one including ejection fraction plus delta ejection fraction.
Conclusions:
In clinically stable patients with chronic heart failure, ejection fraction and its changes were independently associated with outcome; on the contrary, serial cardiopulmonary exercise testing did not provide significant prognostic value. Baseline plus changes in ejection fraction showed better prognostic performance than baseline ejection fraction alone.
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