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Predictors of prognosis in severe chronic heart failure
J Parameshwar1, J Keegan, J Sparrow
1National Heart and Lung Institute, London, England.
Insights
Prognosis in chronic heart failure patients can be predicted using plasma sodium levels, left ventricular ejection fraction, and peak oxygen consumption. These key indicators help determine outcomes like death or cardiac transplantation.
Area of Science:
- Cardiology
- Exercise Physiology
- Medical Prognostics
Background:
- Chronic heart failure (CHF) significantly impacts patient prognosis and quality of life.
- Severe ventricular dysfunction is common in CHF patients referred for exercise testing.
- Identifying reliable prognostic markers is crucial for managing CHF.
Purpose of the Study:
- To retrospectively identify parameters predictive of prognosis in patients with chronic heart failure.
- To determine which clinical and exercise variables independently predict adverse outcomes (death or cardiac transplantation).
Main Methods:
- Retrospective analysis of 127 CHF patients referred to an exercise laboratory.
- Follow-up for a mean of 14.6 months to record outcomes (death or cardiac transplantation).
- Multivariate analysis to identify independent predictors of outcome from a list of clinical, echocardiographic, and exercise variables.
Main Results:
- Plasma sodium level, left ventricular ejection fraction, and peak oxygen consumption were identified as statistically significant and independent predictors of outcome.
- These three variables remained predictive even in a cohort with severe ventricular dysfunction.
- Univariate analysis showed other factors also affected outcome, but multivariate analysis pinpointed these three key predictors.
Conclusions:
- Plasma sodium level, left ventricular ejection fraction, and peak oxygen consumption are crucial prognostic indicators in chronic heart failure.
- These markers can aid in predicting adverse events and guiding clinical management strategies for CHF patients.
- The findings underscore the importance of integrating clinical, imaging, and exercise testing data for comprehensive prognostic assessment.
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 dysfunction with a median ejection fraction 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 failure affected outcome on univariate analysis, multivariate analysis identified three variables 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.