title: Predictors of low cardiac output in decompensated severe heart failure.
abstract: OBJECTIVE
  To identify predictors of low cardiac output and mortality in decompensated heart failure.
  
  
  BACKGROUND
  Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial.
  
  
  METHODS
  We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of <0.45. Patients underwent clinical-hemodynamic assessment and Chagas disease immunoenzymatic assay. Low cardiac output was defined according to L and C clinical-hemodynamic profiles. Multivariate analyses assessed clinical outcomes. P<0.05 was considered significant.
  
  
  RESULTS
  The mean age was 60.1 years; 245 (54.2%) patients were >60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001), lower ejection fraction (RR: 2.414, P<0.001), hyponatremia (RR: 1.618, P = 0.036), and renal dysfunction (RR: 1.916, P = 0.007). Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001). Predictors of mortality were Chagas disease (RR: 2.286, P<0.001), ischemic etiology (RR: 1.449, P = 0.035), and low cardiac output (RR: 1.419, P = 0.047).
  
  
  CONCLUSIONS
  In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.
authors.affiliation: Heart Institute, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil. marcelo.ochiai@incor.usp.br
authors.forename: Marcelo Eidi
authors.initials: ME
authors.lastname: Ochiai
authors.forename: Juliano Novaes
authors.initials: JN
authors.lastname: Cardoso
authors.forename: Kelly Regina Novaes
authors.initials: KR
authors.lastname: Vieira
authors.forename: Marcelo Villaça
authors.initials: MV
authors.lastname: Lima
authors.forename: Euler Cristovan Ochiai
authors.initials: EC
authors.lastname: Brancalhao
authors.forename: Antonio Carlos Pereira
authors.initials: AC
authors.lastname: Barretto
mesh_terms: D002303:Cardiac Output, Low / Q000453:epidemiology / Q000209:etiology*; D014355:Chagas Disease / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007010:Hyponatremia / Q000150:complications; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012016:Reference Values; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain