[Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function].
OBJECTIVE
To compare the clinical characteristics and short- and long-term prognosis for chronic heart failure with left ventricular systolic dysfunction or preserved systolic function.


METHODS
Three-hundred twenty-eight consecutive patients with decompensated chronic heart failure were studied prospectively. Depending on ejection fraction, participants were classified as having systolic dysfunction (group 1, ejection fraction < or = 40%,) or preserved systolic function (group 2, ejection fraction >40%).


RESULTS
Systolic dysfunction was detected in 192 patients (58.5%) and preserved systolic function in 41.5%. Mean age was 62.7 (12.5 years) in group 1 and 65.2 (16.2 years) in group 2 (P=.03), with a male prevalence of 73.3% and 49.3%, respectively (P<.001). Ischemic cardiomyopathy was more frequent in group 1 (44.8% vs 25%; P<.001). Physical examination and electrocardiogram findings were similar in both groups, except for a higher proportion of patients in group 1 with a heart third sound (43.2% vs 25%; P=.001) and left bundle branch block (40.6% vs 15.4%; P<.001) and abnomal Q waves (31.3% vs 20.6%; P=.04). In-hospital mortality was similar in patients with systolic dysfunction and preserved systolic function (2.9% vs 1%; P=NS). Twenty-four-month cumulative survival was 61% for patients with systolic dysfunction and 76% for patients with preserved systolic function (log rank test P=NS). In the Cox proportional hazards model, which included age, sex, functional class, hepatomegaly, peripheral hypoperfusion, BUN, sodium level, ejection fraction > 40%, and biventricular heart failure, preserved systolic function was not associated with late mortality. The variables that were independent predictors of late mortality were peripheral hypoperfusion (OR = 3.7; P<.0001), low sodium level (OR=0.9; P=.009) and male sex (OR=1.9; P=.041).


CONCLUSIONS
Decompensated chronic heart failure with preserved systolic function was more frequent in women and older patients. Patients with preserved systolic function had a lower prevalence of coronary heart disease. However, these differences had no impact on the short- and long-term prognosis.
Macín
Stella M
SM
Instituto de Cardiología Juana Francisca Cabral. Corrientes. Argentina. macinucic@hotmail.com
Perna
Eduardo R
ER
Címbaro Canella
Juan P
JP
Alvarenga
Pablo
P
Pantich
Rolando
R
Ríos
Nelson
N
Farías
Eduardo F
EF
Badaracco
Jorge R
JR
D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013599:Systole / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D016277:Ventricular Function, Left / Q000502:physiology
D002316:Cardiotonic Agents