title: Incremental prognostic value of exercise hemodynamic variables in chronic congestive heart failure secondary to coronary artery disease or to dilated cardiomyopathy.
abstract: To determine the prognostic value of hemodynamic variables at rest and during exercise, 49 patients with chronic congestive heart failure undergoing hemodynamic evaluation at rest and during symptom-limited exercise were followed for 1 year. One-year mortality rate was 33%. On univariate analysis, nonsurvivors differed significantly from survivors in pulmonary arterial wedge pressure at rest (22 +/- 10 vs 15 +/- 10 mm Hg; p = 0.01) and during exercise (32 +/- 9 vs 24 +/- 9 mm Hg; p = 0.003), stroke work index at rest (19 +/- 6 vs 25 +/- 9 g-m/m2; p = 0.03) and during exercise (20 +/- 7 vs 32 +/- 14 g-m/m2; p = 0.001) and exercise-induced increment in stroke work index (0.5 +/- 0.4 vs 7 +/- 8 g-m/m2; p = 0.004), but not with respect to left ventricular ejection fraction, exercise duration, peak oxygen consumption or peak left ventricular hydraulic power. Patients with a peak exercise stroke work index less than 20 g-m/m2 had a 66% mortality rate compared with a mortality rate of 13% in patients with a peak exercise stroke work index greater than 20 g-m/m2 (p = 0.0001). Multiple logistic regression analysis identified pulmonary arterial wedge pressure at rest and peak exercise stroke work index as the only independent predictors of mortality. A receiver-operating characteristic curve analysis revealed that peak exercise stroke work index provided significant incremental prognostic information over the resting hemodynamic variables.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048.
authors.forename: B P
authors.initials: BP
authors.lastname: Griffin
authors.forename: P K
authors.initials: PK
authors.lastname: Shah
authors.forename: J
authors.initials: J
authors.lastname: Ferguson
authors.forename: S A
authors.initials: SA
authors.lastname: Rubin
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002140:California / Q000453:epidemiology; D002245:Carbon Dioxide / Q000378:metabolism; D002302:Cardiac Output / Q000502:physiology; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D002908:Chronic Disease; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012372:ROC Curve; D012146:Rest; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D002245:Carbon Dioxide