Evaluation of heart failure prognostic factors in patients referred for heart transplantation.
OBJECTIVE
To evaluate the survival of patients with heart failure submitted to cardiac transplantation screening as well as identify poor prognostic factors using a risk score to identify patients with higher death risk.


METHODS
330 male and female patients aged 12 to 74 years old, referred for heart transplantation from January 1986 to November 2001 were evaluated. Clinical, laboratory, electrocardiographic, Holter monitoring, echocardiographic and radionuclide ventriculography data were analyzed.


RESULTS
The median follow up period was 5 years; patients' survival rate was 84.5% in the first year, 74.3% in the second year, 68.9% in the third year and 60.5% in the fifth year. The prognostic variables selected through the univariate analysis were: age, Chagas' disease etiology for cardiomyopathy, NYHA functional classes III and IV, orthopnea, systolic blood pressure, mean blood pressure, pulse pressure, plasma urea, sodium, glucose, albumin, bilirubin, hemoglobin, and mean heart rate. The prognostic variables at the multivariate analysis were: ejection fraction, blood urea, and hemoglobin. The risk score: RR=exp[(-0.0942401 x ejection fraction) + (0.0105207 x blood urea) + (-0.2974991 x hemoglobin) + (-0.0132898 x age) + (-0.0099115 x blood glucose)] discriminated the population with a higher death risk.


CONCLUSIONS
Patients' survival was satisfactory despite heart failure severity, suggesting they can be maintained on optimized clinical treatment until persistent clinical deterioration takes place. Ejection fraction, ventricular diameters, and clinical functional class alone should not be used as an indication for heart transplantation. The risk score could help discriminate the population with the poorest prognosis.
Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brasil. cmedina@cardiol.br
Cleópatra Medina Noronha
CM
Areosa
Dirceu Rodrigues
DR
Almeida
Antônio Carlos C de
AC
Carvalho
Angelo A V de
AA
Paola
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001938:Brazil / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000150:complications; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006334:Heart Function Tests; D006339:Heart Rate / Q000502:physiology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology