title: Three year mortality in heart failure patients with very low left ventricular ejection fractions.
abstract: BACKGROUND
  Left ventricular ejection fraction is a predictor of the outcome in patients with chronic heart failure. Some treatments cause a small increase in ejection fraction and may, thereby, improve prognosis.
  
  
  METHODS
  We studied 99 patients with heart failure and very low left ventricular ejection fractions (all < or =20%). Seventy-four patients had ejection fractions of 11-20% and 25 had < or =10%. Patient follow up was censored at three years.
  
  
  RESULTS
  Mortality was 74% at three years. Left ventricular ejection fraction was not a predictor of mortality (P = 0.36). In contrast, peak VO2 at the beginning of the study was a strong predictor of outcome (P = 0.002).
  
  
  CONCLUSIONS
  Three year survival is low when ejection fraction is very low. However, once the ejection fraction is < or =20% ejection fraction is no longer a predictor of mortality. These results suggest that it is unlikely that small increases in ejection fraction will be associated with a survival benefit in this group, and treatments aimed at increasing peak VO2 may be more appropriate.
authors.affiliation: Department of Cardiac Medicine, National Heart and Lung Institute, London, UK. j.niebauer@ic.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Niebauer
authors.forename: A L
authors.initials: AL
authors.lastname: Clark
authors.forename: S D
authors.initials: SD
authors.lastname: Anker
authors.forename: A J
authors.initials: AJ
authors.lastname: Coats
mesh_terms: D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology