Bajraktari, G; Emini, M; Shabani, X; Berisha, V; Selmani, H; Rexhepaj, N; Elezi, S; Ndrepepa, G
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.