Abstract 2703: Clinical and neurohormonal correlates and prognostic value of Kansas City Cardiomyopathy Questionnaire in patients with chronic heart failure
Chronic heart failure (CHF) is characterized by limited exercise activity, enhanced immune activation, and increased morbidity and mortality. Although quality of life and physical activity assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ functional and overall) have been used for the clinical evaluation of CHF patients, the prognostic value as well as the relationship of this questionnaire with neurohormonal/immune activation remain uknown.
Methods: One hundred thirty seven consecutive stable CHF patients (aged 64 ± 12 yrs, mean NYHA class: 2.9 ± 0.6, mean left ventricular ejection fraction: 26±7% ) were evaluated by the above questionnaire, Zung 20-item self rating and Beck Depression Inventory (BDI) scales, Duke physical activity score, plasma BNP, plasma cytokines (IL-6, IL-10 and TNF-a) and 6-min walking test. Patients were monitored for a 8-month follow-up period for disease progression defined as death and/or hospitalization.
Results: The mean KCCQ functional and overall scores were 44±20% and 33±19%, respectively. Patients (n=41) with KCCQ overall score <50% had significantly higher Zung (46±10 vs 34±9, p<0.01) and BDI (18±10 vs 8±6, p<0.01) scales, plasma BNP (900±801 vs 543±374 pg/ml, p<0.05) and plasma IL-6 (12.7±7 pg/ml vs 8.5±6.4 pg/ml, p<0.05) as well as lower DUKE score (15±10 vs 28±13, p<0.01), 6-min walking distance (259±200 vs 363±113 m, p<0.001) and plasma anti-inflammatory cytokine IL-10 (6.1±3.2 pg/ml vs 9.4±5.4 pg/ml, p <0.05) as compared to those (n=96) with score >50%. KCCQ overall score was significantly corellated with plasma BNP levels (r=-0.42, p<0.01), 6-min walking distance (r=0.47, p<0.01) and BDI scale (r=-0.61, p<0.001). Finally, patients with KCCQ overall score >50% had longer event-free survival (182±13 vs 122±15 days, p<0.05) than those with score <50%.
Conclusion: KCCQ is a valuable tool for the evaluation of severity of clinical and emotional symptoms of CHF patients, closely related with their neurohormonal/immune activation and seems to have important prognostic value in CHF.