Predictors of prognosis in patients awaiting heart transplantation

J Heart Lung Transplant. Sep-Oct 1993;12(5):756-65.

Abstract

Patients enrolled in a clinical heart transplantation program were evaluated to identify the predictors of prognosis in patients with advanced heart disease and to optimize timing of heart transplantation. Three hundred eighty-eight subjects were consecutively evaluated from 1985 through 1989. One hundred eighty-four patients (47.5%) had dilated cardiomyopathy; 164 patients (42.2%) had ischemic heart disease; 34 patients (8.8%) had valvular heart disease, and six patients (1.5%) had miscellaneous disorders. In each patient, 45 different parameters were considered. During follow-up (mean, 8.4 months) 166 patients underwent heart transplantation; 99 patients died (heart failure, 66 patients; sudden death, 26 patients; thromboembolism, two patients; noncardiac causes, five patients). The actuarial survival was 83% at 3 months, 77% at 6 months, 73% at 9 months, 70% at 1 year, and 59% at 2 years. The median survival time was 28 months. Analysis by Cox proportional hazard regression model revealed seven independent and significant prognostic factors: etiology (p < 0.05), NYHA class (p < 0.05), third heart sound (p < 0.05), diastolic pulmonary artery pressure (p < 0.05), pulmonary wedge pressure (p < 0.01), mean systemic blood pressure (p < 0.05), and cardiac output (p < 0.05). Cox's analysis allows the computation of patient-specific curves for predictions of residual survival time at any moment during follow-up. Moreover it can be used to calculate a simple prognostic index, which enables stratification of the patient population into three risk classes: patients at high (n = 105), intermediate (n = 160) and low (n = 123) risk of early death. Pairwise comparisons of survival between the classes were significant at 1% level.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Pressure / physiology
  • Cardiac Output / physiology
  • Cardiomyopathy, Dilated / drug therapy
  • Cardiomyopathy, Dilated / physiopathology
  • Child
  • Coronary Disease / drug therapy
  • Coronary Disease / physiopathology
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Forecasting
  • Heart Diseases / physiopathology*
  • Heart Transplantation / physiology
  • Heart Transplantation / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Risk Factors
  • Stroke Volume / physiology
  • Survival Rate
  • Ventricular Function, Left / physiology