How does systolic function affect long-term outcome in heart failure?

Congestive heart failure (CHF) is a major public health problem associated with markedly diminished survival. Yet, studies have reported that left ventricular systolic function remains nearly normal in a high proportion (13% to 75%) of patients with CHF, conferring a better prognosis (annual mortality: 1.3% to 17.5%) than in patients whose left ventricular systolic function is impaired. The variability in these prevalence and prognosis figures reflects the selection bias of the studies concerned, eg, community vs hospital population, or middle vs old age.

The Framingham community study found that heart failure with preserved left ventricular function is more common in women, especially those with no history of myocardial infarction. A normal ejection fraction confers a better prognosis than reduced pump function indices; in particular, it halves the mortality rate, although this remains 4-fold higher than in subjects without heart failure, reinforcing the message that the heart failure syndrome, irrespective of its etiology, severely curtails short- and long-term survival.

A prospective cardiac catheterization study of. 2498 consecutive patients with New York Heart Association class II to IV symptoms and an ejection fraction >40% reported an overall 5-year mortality of 28%, confirming that the prognosis of heart failure with preserved left ventricular function is halfway between that of heart failure with a low left ventricular ejection fraction and normal controls.

Echeverria HH, Blisker MS, Myerburg RJ, Kessler KM. Congestive heart failure: echocardiographic insights. Am J Med. 1983;73:750-755. Gillum RF. Epidemiology of heart failure in United States. Am Heart J. 1993;126:1042-1047.

O’Connor CM, Gattis WA, Shaw L, Cuffe MS, Califf RM. Clinical characteristics and long-term outcomes of patients with heart failure and preserved systolic function. Am J Cardiol. 2000;86:863-867.

Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol. 1995;26:1565-1574.

Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D.

Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol. 1999;33:1948-1955.

Keywords

symptom; diagnosis; systolic ventricular function; prognosis; ejection fraction

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