Predictors of mortality in medically treated patients with congestive heart failure of nonrheumatic etiology and reduced systolic function.

OBJECTIVE

We investigated the prognostic value of various parameters on the mortality of patients with nonrheumatic chronic heart failure and left ventricular (LV) systolic dysfunction.

METHODS

This study included 132 consecutive patients with congestive heart failure and reduced LV systolic function without rheumatic valve disease. The primary outcome was mortality. Mean follow-up was 38+/-6 months.

RESULTS

During the follow-up period there were 47 deaths (35.6%). The age (64.1+/-13.5 vs. 58.7+/-11.8 years, P=0.019), left bundle branch block (44.7% vs. 18.8%, P=0.002), urea concentration (11.4+/-5.3 vs. 8.9+/-4.6 mmol/L, P=0.006), LV end-diastolic and end-systolic dimensions (6.7+/-0.8 vs. 6.4+/-0.8 cm, P=0.025 and 5.5+/-0.8 vs. 4.9+/-0.8 cm, P<0.001, respectively), grade 3-4 mitral regurgitation (40.4 vs. 22.4%, P<0.001), fractional shortening (16.7+/-5.3% vs. 19.8+/-5.7%, P=0.002) and LV ejection fraction (32.9+/-8.5% vs. 38.7+/-11.3%, P=0.003) were different between non-survivors and survivors. Multivariate analysis identified severity of mitral regurgitation (OR=1.99, 95% CI 1.18-3.34; P=0.009), age (OR=1.07, 95% CI 1.02-1.12; P=0.01) and LV end-systolic dimension (OR=1.09, 95% CI 1.02-1.16; P=0.014) as independent correlates of mortality.

CONCLUSIONS

In medically treated patients with nonrheumatic chronic heart failure and left ventricular systolic dysfunction, severity of mitral regurgitation, age and enlarged LV end-systolic dimension were independently associated with increased risk of death.