Long term prognosis of chronic heart failure: reduced vs preserved left ventricular ejection fraction

Circ J. 2009 Jan;73(1):92-9. doi: 10.1253/circj.cj-07-1016. Epub 2008 Dec 1.

Abstract

Background: Left ventricle diastolic dysfunction is attracting increasing attention of one of the etiologies of chronic heart failure (CHF).

Methods and results: The study sample included 560 patients with CHF who were hospitalized during the 5-year period. They were classified into 2 groups according to the left ventricular ejection fraction (LVEF): reduced group (LVEF <50%, n=431); or preserved group (LVEF >or=50%, n=129). The degree of cardiac symptoms did not differ between the 2 groups; however, no difference was found between the 2 groups in the mortality rate (P=0.898), and readmission rates (P=0.674). The results of a multivariate analysis using a Cox proportional hazards model to identify predictors of the prognosis of heart failure revealed no difference in prognosis according to the presence/absence of decreased LVEF, whereas renal dysfunction and anemia were identified as significant prognostic determinants. Also, in the reduced group, the administration of angiotensin-converting enzyme inhibitors (ACE-I) and/or angiotensin II receptor blockers (ARB), beta-blockers reduced mortality. In the preserved group, ACE-I and/or ARB administration reduced mortality, whereas beta-blockers did not.

Conclusion: In the present study, the likelihood of LVEF influencing prognosis was considered to be low, with the contribution of non-cardiac factors such as renal function and anemia concluded to be greater.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anemia / physiopathology
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnosis*
  • Heart Failure / drug therapy
  • Heart Failure / physiopathology*
  • Humans
  • Kaplan-Meier Estimate
  • Kidney / physiopathology
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Stroke Volume / physiology*
  • Ventricular Dysfunction, Left / drug therapy
  • Ventricular Dysfunction, Left / physiopathology*
  • Ventricular Function / physiology*

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors