Lethal outcomes in patients with symptomatic heart failure developed after Q-wave myocardial infarction.

The article analyses clinical characteristics and mortality of patients with symptomatic chronic heart failure following Q-wave myocardial infarction. During the study 224 patients (mean age 64.1+/-9.7) with symptomatic chronic heart failure and left ventricular ejection fraction <40% were followed-up for 1-5 years (on the average, 2.6+/-2.0 years). The majority of the studied patients had had anterior or anterior-lower Q-wave myocardial infarction (61.6% and 25.9%, respectively) and an identified Canadian function class II-IV angina pectoris (74.6%), and one-fifth of the patients (19.6%) had unstable angina pectoris. All patients were diagnosed with chronic heart failure New York Heart Association function class II-IV, the majority of patients had disturbances in cardiac rhythm and conduction, almost a half of them (46.0%) had left ventricular aneurysm, 92.8% of patients were diagnosed with marked changes in left ventricular geometry, 84.4% of patients had II-IV degrees mitral regurgitation, a half of the patients had significant left ventricular diastolic dysfunction, and 6.3% of patients had previously experienced thromboembolic complications. During the follow-up period 132 patients died. The comparison of the characteristics of patients who survived with those of patients who died showed that the deceased patients were statistically significantly older compared to survivors; in addition to that, marked stenoses of three coronary arteries, severe chronic heart failure, ejection fraction < or =20%, ventricular extrasystoles, and sinal tachycardia were more common in the former group, and patients who died less frequently were overweight and less frequently used beta adrenoblockers. The evaluation of Kaplan-Meier curves showed that total mortality resulting from the development of chronic heart failure symptoms and indications of chronic heart failure during the 1st year was 21.0%, during the 2nd year -40%, during the 3rd year -55.0%, during the 4th year -61.0%, and during the 5th year -65.0% the highest mortality was observed when left ventricular ejection fraction < or =20%, and age >75. The development of severe chronic heart failure resulted, on the average, after 1.5+/-1.1 years. It is obvious that symptomatic chronic heart failure caused by ischemic cardiomyopathy and marked left ventricular systolic dysfunction following Q-wave myocardial infarction is a rapidly progressing process conditioning high risk of lethal outcome within the period of several years.