Abstract 16221: Predictors of Mortality in Patients Hospitalized for Congestive Heart Failure with Left Ventricular Ejection Fraction > 35%
Background: The aim of this study was to evaluate the clinical characteristics, long term mortality, and to identify prognostic factors in patients with LVEF > 35% hospitalized for decompensated congestive heart failure.
Methods: We evaluated a consecutive sample of patients hospitalized in 2003 with discharge diagnosis of heart failure with LVEF > 35%. Patients with severe valvular defects were excluded. Multivariable Cox regression model was developed using baseline clinical characteristics and echocardiographic variables including: LVEF, septal and lateral wall thickness, LV mass, LA size and LV dimension. All-cause mortality was determined from the National Death Registry.
Results: The study population consisted of 193 patients, mean age 77+15 years (60% female) with mean follow-up of 4.0±2.8 years. Hypertension was reported in 74% patients. Cumulative 5-year mortality was 57%; mortality in quartile 1 (<4.1 cm) vs. quartiles 2-4 (>4.1 cm) of LVEDD is shown in the Figure. In multivariable Cox model, predictors of mortality were: BUN >25 (HR=1.77; p=002); absence of hypertension (HR= 1.61; p=0.022) and LVEDD in 1st quartile: < 4.1 cm (HR=1.59; p=0.026). There was no significant difference in LV mass or LV wall thickness between patients with LVEDD ≥4.1 versus <4.1 cm. Separate analysis evaluating the risk of early mortality, defined as 3-year mortality yielded similar results.
Conclusions: Mortality among patients hospitalized for heart failure with LVEF > 35% remains very high. Higher BUN, absence of hypertension and lower LVEDD (<4.1 cm) are associated with increased mortality in hospitalized heart failure patients. Lower LVEDD (<4.1 cm) is an independent predictor of mortality in heart failure patients with LVEF>35%. A lower LVEDD may represent a “stiff” ventricle with compromised diastolic heart function.
- © 2012 by American Heart Association, Inc.