title: Left ventricular systolic function in the prognosis of patients hospitalized due to worsening heart failure.
abstract: BACKGROUND
  Preserved left ventricular systolic function (LVSF) is observed in up to 50% of patients with heart failure (HF). We aimed to determine the prognostic value of LVSF and identify prognostic indices in patients hospitalized due to HF with preserved and depressed LVSF.
  
  
  METHODS
  We evaluated clinical records of 304 patients admitted due to decompensated HF, with ECG, echocardiogram and plasma NT-proBNP determination. The endpoint was death or hospital readmission within 6 months.
  
  
  RESULTS
  Patients with preserved LVSF were more frequently women (72.9% vs. 45.0%, p < 0.001) and were more frequently in atrial fibrillation (56.3% vs. 35.6%, p < 0.001). NT-proBNP values at discharge were higher in patients with depressed LVSF (median 5291 [2050-10306] vs. 2146 [1048-4052] pg/ml, p < 0.001). Among patients with preserved LVSF, predictors of adverse events were male ender, hemoglobin, serum creatinine and serum sodium levels at discharge. Among patients with depressed LVSF, predictors of adverse events were male gender, atrial fibrillation, non-prescription of ACE inhibitors at discharge and NT-proBNP levels at discharge. Death or hospital readmission occurred in 40 patients with preserved LVSF and 95 with depressed LVSF (HR = 1.20 [95% CI: 0.83-1.73]).
  
  
  CONCLUSIONS
  Our results show an ominous prognosis of acute HF, regardless of LVSF, in an elderly HF population. Patients with preserved LVSF presented weaker neurohumoral activation, These results reinforce the need for closer follow-up and aggressive strategies irrespective of systolic function in HF patients.
authors.affiliation: Departamento de Medicina Interna, Hospital São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal. alexandra.g@netcabo.pr
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Rui
authors.initials: R
authors.lastname: Almeida
authors.forename: Joana
authors.initials: J
authors.lastname: Mascarenhas
authors.forename: Marta
authors.initials: M
authors.lastname: Patacho
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha-Gonçalves
authors.forename: António
authors.initials: A
authors.lastname: Ferreira
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013599:Systole; D016277:Ventricular Function, Left