Long-term prognosis and risk factors for cardiac adverse events in patients with chronic systolic heart failure due to hypertension.
OBJECTIVE
The long-term prognosis and predictors of adverse cardiac events in hypertension-related chronic systolic heart failure (CHF) remain uncertain. Therefore, we sought to determine the major adverse cardiac events (MACE) in this group of patients.


METHODS
One hundred and thirty two patients (83% males, age 48.6 +/- 8.2 years) in NYHA class II and III with hypertension-related chronic CHF were prospectively evaluated for three years. Hypertension was defined as blood pressure > or = 140/90 mmHg documented clinically twice for at least 5 years before the onset of CHF symptoms. All patients underwent coronary angiography to exclude coronary artery disease as a cause of CHF. Analysis of predictors of MACE (death, urgent heart transplantation and re-admission to the hospital due to CHF progression) during the 3 years of follow up was performed.


RESULTS
After follow up the frequency of MACE was 41.7%. The independent predictors of MACE occurrence were as follows: the symptoms of depression [hazard ratio (HR) 2.58 (95% CI 1.44-4.63, p < 0.01)], end-diastolic diameter of the right ventricular (EDDRV) [HR 1.07 (95% CI 1.02-1.12, p < 0.01)] and D-dimers [HR 2.24 (95% CI 1.08-4.67, p < 0.05)]. To define optimal prognostic accuracy of EDDRV and D-dimers the receiver operating characteristics curve analysis was performed. The cut-off for EDDRV was 28 mm (sensitivity 50%, specificity 67.6%, area under curve [AUC] 0.64, p < 0.01) and for D-dimers 0.23 microg/ml, (sensitivity 58%, specificity 64.2%, AUC 0.62, p < 0.05).


CONCLUSIONS
In analysed group the symptoms of depression, higher baseline right ventricular diastolic diameter and higher baseline D-dimers level were independent predictors of MACE.
Szyguła-Jurkiewicz
Bozena
B
III Department of Cardiology in Zabrze, Medical University of Silesia, Katowice, Poland. b.szygula@sccs.pl
Owczarek
Aleksander
A
Duszańska
Agata
A
Sikora
Jacek
J
Lekston
Andrzej
A
Pudlo
Robert
R
Wojnicz
Romuald
R
Poloński
Lech
L
D000328:Adult; D002908:Chronic Disease; D003863:Depression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D