Korean Circ J.  2012 Oct;42(10):659-667. 10.4070/kcj.2012.42.10.659.

Prognostic Estimation of Advanced Heart Failure With Low Left Ventricular Ejection Fraction and Wide QRS Interval

• Oh C
• Chang HJ
• Sung JM
• Kim JY
• Yang W
• Shim J
• Kang SM
• Ha J
• Rim SJ
• Chung N

• KMID: 1826462
• DOI: http://doi.org/10.4070/kcj.2012.42.10.659

Abstract

BACKGROUND AND OBJECTIVES
Cardiac resynchronization therapy (CRT) has been known to improve the outcome of advanced heart failure (HF) but is still underutilized in clinical practice. We investigated the prognosis of patients with advanced HF who were suitable for CRT but were treated with conventional strategies. We also developed a risk model to predict mortality to improve the facilitation of CRT.
SUBJECTS AND METHODS
Patients with symptomatic HF with left ventricular ejection fraction < or =35% and QRS interval >120 ms were consecutively enrolled at cardiovascular hospital. After excluding those patients who had received device therapy, 239 patients (160 males, mean 67+/-11 years) were eventually recruited.
RESULTS
During a follow-up of 308+/-236 days, 56 (23%) patients died. Prior stroke, heart rate >90 bpm, serum Na < or =135 mEq/L, and serum creatinine > or =1.5 mg/dL were identified as independent factors using Cox proportional hazards regression. Based on the risk model, points were assigned to each of the risk factors proportional to the regression coefficient, and patients were stratified into three risk groups: low- (0), intermediate-(1-5), and high-risk (>5 points). The 2-year mortality rates of each risk group were 5, 31, and 64 percent, respectively. The C statistic of the risk model was 0.78, and the model was validated in a cohort from a different institution where the C statistic was 0.80.
CONCLUSION
The mortality of patients with advanced HF who were managed conventionally was effectively stratified using a risk model. It may be useful for clinicians to be more proactive about adopting CRT to improve patient prognosis.

Keyword

Heart failure; Prognosis; Cardiac resynchronization therapy

MeSH Terms

Cardiac Resynchronization Therapy
Cohort Studies
Creatinine
Follow-Up Studies
Heart
Heart Failure
Heart Rate
Humans
Male
Mustard Compounds
Prognosis
Risk Factors
Stroke
Stroke Volume
Creatinine
Mustard Compounds

Figure

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  Fig. 1 Diagram of study workflow. CHF: congestive heart failure, LVEF: left ventricular ejection fraction, ICD: implantable cardioverter-defibrillator.

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  Fig. 2 Primary outcome: all-cause death. Secondary outcome: the composite of all-cause death or unplanned hospitalization due to major adverse cardiovascular event.

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  Fig. 3 Kaplan-Meier survival curves for the derivation cohort (A) and the validation cohort (B).

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