title: Static and dynamic predictors of adverse events in patients with intermediate cardiopulmonary capacity referred for heart transplantation.
abstract: BACKGROUND
  Chronic heart failure (CHF) patients with intermediate cardiopulmonary capacity referred for heart transplantation are at "medium risk," and are not amenable to further stratification based solely on peak VO(2.) Accordingly, we analyzed whether time-related and/or non-time-related parameters could provide incremental prognostic information in CHF patients with intermediate cardiopulmonary capacity.
  
  
  METHODS
  We analyzed 134 patients with a peak VO(2) of 10 to 18 ml/kg/min (age 54 +/- 9 years, 66% males) and a left ventricular ejection fraction (LVEF) of 27% +/- 8% who underwent an extensive clinical/instrumental (electrocardiogram, echocardiogram, cardiopulmonary exercise test) index evaluation; for all patients, an equivalent pre-study evaluation (performed >or=6 months before) was also available.
  
  
  RESULTS
  Among index-evaluation parameters, systolic blood pressure (p < 0.001), LVEF (p = 0.036), and presence of severe mitral regurgitation (p = 0.006) independently predicted cardiac death/need for heart transplantation. Stable clinical condition from pre-study to index-evaluation accompanied by <10% QRS widening and <10% decrease in peak VO(2) provided incremental prognostic information with respect to all index-evaluation parameters (p = 0.014).
  
  
  CONCLUSIONS
  CHF patients with intermediate peak VO(2) who display "stable" CHF present a lower incidence of adverse cardiac events, particularly in the absence of hypotension, severe mitral regurgitation, and severe reduction of LVEF. Such a stratification might be clinically useful for deciding between medical treatment alone and consideration for heart transplantation.
authors.affiliation: Institute of Cardiology, S. Orsola-Malpighi University Hospital, Bologna, Italy. francesco.grigioni@unibo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.forename: Antonio
authors.initials: A
authors.lastname: Russo
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.forename: Francesca
authors.initials: F
authors.lastname: Fabbri
authors.forename: Letizia
authors.initials: L
authors.lastname: Bacchi-Reggiani
authors.forename: Samuela
authors.initials: S
authors.lastname: Carigi
authors.forename: Anna C
authors.initials: AC
authors.lastname: Musuraca
authors.forename: Mauro
authors.initials: M
authors.lastname: Bigliardi
authors.forename: Fabio
authors.initials: F
authors.lastname: Coccolo
authors.forename: Gaia
authors.initials: G
authors.lastname: Magnani
authors.forename: Salvatore
authors.initials: S
authors.lastname: Specchia
authors.forename: Carlo
authors.initials: C
authors.lastname: Magelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000328:Adult; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis