title: Clinical characteristics and predictors of in-hospital mortality in acute heart failure with preserved left ventricular ejection fraction.
abstract: Acute heart failure (AHF) with preserved left ventricular ejection fraction (PLVEF) represents a significant part of AHF syndromes featuring particular characteristics. We sought to determine the clinical profile and predictors of in-hospital mortality in patients with AHF and PLVEF in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). This survey is an international observational study of 4,953 patients admitted for AHF in 9 countries (6 European countries, Mexico, and Australia) from October 2006 to March 2007. Patients with PLVEF were defined by an LVEF ≥ 45%. Of the total cohort, 25% of patients had PLVEF. In-hospital mortality was significantly lower in this subgroup (7% vs 11% in patients with decreased LVEF, p = 0.013). Candidate variables included demographics, baseline clinical findings, and treatment. Multivariate logistic regression analysis showed that the variables independently associated with in-hospital mortality included systolic blood pressure at admission (p <0.001), serum sodium (p = 0.041), positive troponin result (p = 0.023), serum creatinine >2 mg/dl (p = 0.042), history of peripheral vascular disease and anemia (p = 0.004 and p = 0.015, respectively), secondary (hospitalization for other reason) versus primary AHF diagnosis (p = 0.043), and previous treatment with diuretics (p = 0.023) and angiotensin-converting enzyme inhibitors (p = 0.021). In conclusion, patients with AHF and PLVEF have lower in-hospital mortality than those with decreased LVEF. Low systolic blood pressure, low serum sodium, renal dysfunction, positive markers of myocardial injury, presence of co-morbidities such as peripheral vascular disease and anemia, secondary versus primary AHF diagnosis, and absence of treatment with diuretics and angiotensin-converting enzyme inhibitors at admission may identify high-risk patients with AHF and PLVEF.
authors.affiliation: Heart Failure Clinic and Secondary Cardiology Department, Attikon University Hospital, Athens, Greece. jparissis@yahoo.com
authors.forename: John T
authors.initials: JT
authors.lastname: Parissis
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Rafouli-Stergiou
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.forename: Fabio
authors.initials: F
authors.lastname: Vilas-Boas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
mesh_terms: D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology