Abstract 3177: Combined Effects of Creatinine Clearance and Peak Oxygen Consumption in Risk Stratification of Patients With Chronic Systolic Heart Failure
Background: Peak oxygen consumption (PkVO2) remains a potent independent discriminator of survival in patients with chronic systolic heart failure (HF). Our laboratory has shown that the predictive value of PkVO2 can be further enhanced by adjusting this parameter to lean body mass (PkVO2lean). Creatinine clearance (CrCl) has also been shown to be of independent value in stratifying risk in cardiac populations. We sought to evaluate the independent contribution of these and other parameters in 875 patients with chronic HF
Methods: We assessed PkVO2 (mean 15.7±5.7 ml/kg/min), PkVO2lean (mean 22.1±7.3 ml/kg/min), ejection fraction (EF, mean = 23.6±9.7%), serum sodium (Na, mean 140±3 mg/dl), hemoglobin (Hb, mean 13.3±10.1 mg/dl), CrCl (mean 86.4 ± 35.8 ml/min), brain natriuretic peptide (BNP, mean 351±462) and mortality in 875 HF patients (mean age 56±13 years; 71% male). Mortality was assessed via the National Death Index after a mean follow-up of 1098 ±662 days.
By logistic regression PkVO2lean (Chi square = 26.5, p<0.0001), male gender (Chi square =11.1, p=0.0009), and EF (Chi square = 3.5, p=0.06) were independent predictors of survival. Further stratification of patients with low PkVO2lean by CrCl above or below 50 ml/min improved risk stratification (figure).
Conclusion: In both univariate and multivariate analyses,PkVO2 corrected for lean body mass was the most powerful predictor of survival. Knowledge of CrCl improves risk stratification in HF patients with reduced PkVO2lean. However, survival is unaffected by CrCl in HF patients with normal PkVO2lean.