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Predictors of total mortality and sudden death in mild to moderate heart failure. Captopril-Digoxin Study Group
A Gradman1, P Deedwania, R Cody
1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510.
Insights
Left ventricular ejection fraction and ventricular tachycardia frequency are key predictors of mortality in heart failure patients. Lower ejection fraction and higher tachycardia rates significantly increase death risk, guiding clinical management.
Area of Science:
- Cardiology
- Clinical Trials
- Heart Failure Research
Background:
- Mild to moderate heart failure patients (n=295) were studied in a multicenter trial.
- Baseline characteristics included left ventricular ejection fraction (LVEF) ≤ 40% and New York Heart Association (NYHA) functional class II in 81% of participants.
- Heart failure etiology was 62% ischemic and 38% nonischemic.
Purpose of the Study:
- To examine the relationship between baseline clinical variables and subsequent mortality in heart failure patients.
- To identify independent predictors of total and sudden death in this cohort.
Main Methods:
- Multicenter trial comparing captopril, digoxin, and placebo in addition to diuretics.
- Baseline assessments included LVEF, Holter monitoring for ventricular arrhythmias, and NYHA functional class.
- Univariate and multiple logistic regression analyses were used to determine predictors of mortality over a 16-month follow-up.
Main Results:
- Left ventricular ejection fraction (LVEF) was the strongest predictor of total mortality (p=0.006); mortality was 27% for LVEF ≤ 20% vs. 7% for LVEF ≥ 30%.
- Ventricular tachycardia (VT) frequency independently predicted total mortality (p=0.008) and sudden death (p=0.003); mortality was 34% with VT > 0.088 events/h vs. 12% without.
- NYHA functional class (p=0.02) and nonischemic heart disease etiology (p=0.04) were also independent predictors of mortality.
Conclusions:
- Baseline LVEF and VT frequency are critical prognostic indicators in patients with mild to moderate heart failure.
- Nonischemic etiology and higher NYHA functional class also independently predict mortality.
- These findings highlight the importance of assessing LVEF and ventricular arrhythmias for risk stratification and management.
Abstract:
The relation between baseline clinical variables and subsequent mortality was examined in 295 patients with mild to moderate heart failure who participated in a multicenter trial comparing the effect on treadmill exercise tolerance of captopril, digoxin and placebo given in addition to a diuretic drug. At baseline study, all patients had a left ventricular ejection fraction less than or equal to 40%; 81% were in New York Heart Association functional class II. The etiology of heart failure was ischemic in 62% and nonischemic in 38%. During an average follow-up period of 16 months, 47 patients (16%) died and 24 deaths were classified as sudden. By univariate analysis, left ventricular ejection fraction, ventricular premature beat frequency, couplet frequency, ventricular tachycardia frequency, functional class, treadmill exercise time and nonischemic heart disease were statistically associated with mortality. With multiple logistic regression analysis, left ventricular ejection fraction was identified as the variable most closely associated with total mortality (p = 0.006). Twenty-seven percent of patients with an ejection fraction less than or equal to 20% died compared with 7% with an ejection fraction greater than or equal to 30%. Ventricular tachycardia frequency on Holter monitoring was independently associated with both total mortality (p = 0.008) and sudden death (p = 0.003). Patients with a ventricular tachycardia frequency of greater than 0.088 events/h had a mortality rate of 34% compared with 12% in those without ventricular tachycardia. In the multivariate model, functional class (p = 0.02) and etiology of nonischemic heart disease (p = 0.04) remained as independent predictors of mortality, whereas treadmill exercise duration did not.(ABSTRACT TRUNCATED AT 250 WORDS)