Long term prognosis of chronic heart failure: reduced vs preserved left ventricular ejection fraction.
BACKGROUND
Left ventricle diastolic dysfunction is attracting increasing attention of one of the etiologies of chronic heart failure (CHF).


RESULTS
The study sample included 560 patients with CHF who were hospitalized during the 5-year period. They were classified into 2 groups according to the left ventricular ejection fraction (LVEF): reduced group (LVEF <50%, n=431); or preserved group (LVEF >or=50%, n=129). The degree of cardiac symptoms did not differ between the 2 groups; however, no difference was found between the 2 groups in the mortality rate (P=0.898), and readmission rates (P=0.674). The results of a multivariate analysis using a Cox proportional hazards model to identify predictors of the prognosis of heart failure revealed no difference in prognosis according to the presence/absence of decreased LVEF, whereas renal dysfunction and anemia were identified as significant prognostic determinants. Also, in the reduced group, the administration of angiotensin-converting enzyme inhibitors (ACE-I) and/or angiotensin II receptor blockers (ARB), beta-blockers reduced mortality. In the preserved group, ACE-I and/or ARB administration reduced mortality, whereas beta-blockers did not.


CONCLUSIONS
In the present study, the likelihood of LVEF influencing prognosis was considered to be low, with the contribution of non-cardiac factors such as renal function and anemia concluded to be greater.
Miyagishima
Kenji
K
Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Hiramitsu
Shinya
S
Kimura
Hisashi
H
Mori
Kazumasa
K
Ueda
Tomoya
T
Kato
Shigeru
S
Kato
Yasuchika
Y
Ishikawa
Shiho
S
Iwase
Masatsugu
M
Morimoto
Shin-ichiro
S
Hishida
Hitoshi
H
Ozaki
Yukio
Y
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000503:physiopathology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000503:physiopathology*; D016276:Ventricular Function / Q000502:physiology*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors