The pathogenesis and prognosis of end-stage heart disease.
The final outcome of many forms of heart disease is congestive heart failure (CHF), a condition in which the heart can no longer pump enough blood to fulfill the body's metabolic requirements. Systolic heart failure is characterized by an impairment of myocardial contractility, whereas diastolic heart failure results from the left ventricle's inability to distend normally. The general features of CHF include pressure or volume overload, muscle loss, decreased myocardial contractility, or restrictive filling. Treatment is palliative, and 50% of the patients with CHF can be expected to die within 5 years; the mortality is much higher in those with coronary disease or limiting symptoms. The following signs are associated with a particularly poor prognosis: age > 55 years, cardiomegaly, a cardiac index of < 3, a left-ventricular end-diastolic pressure of > 20 mmHg, an ejection fraction of < 30%, a thin ventricular wall, dyspnea, and evidence of atrial fibrillation or ventricular tachycardia. Because of their high mortality, many of these patients eventually become candidates for cardiac transplantation.
Strickman
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Clayton Foundation for Research Cardiovascular Laboratories, Texas Heart Institute, Houston, Texas 77030, USA.