title: Ejection fraction and blood pressure are important and interactive predictors of 4-week mortality in severe acute heart failure.
abstract: BACKGROUND
  In acute heart failure syndromes (AHFS), the prognostic value of left ventricular ejection fraction (LVEF), although widely accepted, has been recently challenged. In contrast, blood pressure is increasingly gaining ground over LVEF as predictor of mortality. Therefore, it is not clear whether both LVEF and mean arterial pressure (MAP) are independent risk factors in patients with AHFS.
  
  
  RESULTS
  The EFICA study enrolled 581 AHFS patients admitted to 60 CCU/ICUs. Survival at 4 weeks was analyzed for all cases with echocardiographic LVEF available on admission (n=355). Four-week mortality was 23%. Multivariable analysis identified lower LVEF, lower MAP and serum creatinine >1.5 mg/dl as independent correlates of mortality (respectively, OR: 1.27 per 10% decrease, CI: 1.05-1.53, p=0.012; OR: 1.30 per 10 mmHg decrease, CI: 1.15-1.48, p<0.0001; OR: 2.84, CI: 1.64-4.93, p=0.0002). LVEF interacted significantly with MAP (p<0.0001) and the subgroup analysis showed that reduced LVEF was a strong risk factor in patients with MAP <or=90 mmHg (OR: 2.73, CI: 1.23-5.98, p=0.01) but did not reach statistical significance in patients with MAP >90 mmHg.
  
  
  CONCLUSIONS
  Both LVEF and MAP are important predictors of death in severe AHFS. LVEF can provide additional prognostic information on top of MAP but mainly in patients with low MAP (<or=90 mmHg) at admission.
authors.affiliation: Clinical Investigation Center of Nancy, France.
authors.forename: Chris
authors.initials: C
authors.lastname: Adamopoulos
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Renaud
authors.initials: R
authors.lastname: Fay
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: Louis
authors.initials: L
authors.lastname: Guize
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.forename: François
authors.initials: F
authors.lastname: Alla
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume
chemical_list: D003404:Creatinine