[Analysis of risk factors in a group of patients referred for heart transplantation for refractory heart failure: multivariate analysis].
BACKGROUND
In the absence of evident clinical controindication heart transplantation can be performed in patients with critical degree of cardiac failure. The choice of adequate candidates for transplantation is frequently based on clinical severness but also influenced by factors as body size, blood group and so on.


METHODS
To identify the presence of prognostic factors for patients with high risk of death, clinical, hemodynamic and therapeutic features of 70 patients (mean age 44.8 +/- 13.8) with critical cardiac failure (64 patients in IV class N.Y.H.A.) have been reviewed. Most of them were affected by dilated or ischemic cardiomyopathy.


RESULTS
All patients were admitted to Cardiac Intensive Care Unit, 13 patients received transplantation, 24 were discharged and 33 died. Univariate analysis evidenced, that in the group of patients who died, sepsis (p = 0.0003), renal (p = 0.04) and liver function impairment (P = 0.007) occurred significantly more frequent. The differentiated use of catecholamines (P = 0.0007) and of vasodilators (P = 0.007), the need of mechanical ventilation (P = 0.0001) and the need of hemodialysis (P = 0.02) resulted significantly higher in the group of dead patients where mean arterial pressure (p = 0.01) and mean systemic resistances (P = 0.04) resulted significantly lower. With multivariate analysis were identified following independent risk factors of death: male sex, infections, mechanical ventilation, differentiated use of vasodilators, mean arterial pressure and mean pressure in pulmonary artery.


CONCLUSIONS
As predictive risk factors of death in patients with critical cardiac failure and awaiting transplantation resulted: sex, the presence of infection, mechanical ventilation and differentiated use of vasodilators whereas hemodynamic parameters did not result of important predictive value.
Maddalena
F
F
Divisione di Cardiologia, Università degli Studi, Padova.
Boffa
G M
GM
Cacciavillani
L
L
Marzari
A
A
Reimers
B
B
Dalla Volta
S
S
D000328:Adult; D002303:Cardiac Output, Low / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors
Analisi dei fattori di rischio in un gruppo di soggetti riferiti per trapianto cardiaco a causa di uno scompenso cardiaco refrattario: analisi multivariata.