Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Prediction of mortality in mild to moderately symptomatic patients with left ventricular dysfunction
The role of the New York Heart Association classification, cardiopulmonary exercise testing, two-dimensional echocardiography and Holter Monitoring
‘Clinical del Lavoro’ Foundation, IRCCS, Medical Center of Rehabilitation, Division of Cardiology Cassano Murge, Bari
*Institute of Cardiovascular Diseases, University of Bari Bari
Unit of Clinical Epidemiology and Trials, National Institute for Cancer Research Genova, Italy
Received 15 November 1993; revised 3 March 1994; .
Correspondence. Dr Domenico Scrutinio, Fondazione Clinica del Lavoro, Centro Medico di Cassano M., Via per Mercadante, Km 2, 70020 Cassano Murge, Ban, Italy.
Abstract
In order to investigate the value of peak oxygen consumption (peak VO2) in predicting mortality in mild to moderately symptomatic patients with left ventricular dysfunction, we studied 103 NYHA HUH class patients with a left ventricular ejection fraction (LVEF) 
40%. Heart failure was due to coronary artery disease (CAD) in 39 patients, idiopathic dilated cardiomyopathy in 54, hypertension in eight and surgically corrected valvular disease in two. The following variables were analysed: age, cause of heart failure (CAD vs no CAD), NYHA class, peak VO2, LVEF, left ventricular end-systolic volume index (LVESVI), ventricular tachycardia (VT) on Holter monitoring and the use of antiarrhythmic drugs. Statistical analysis was performed by Cox's proportional-hazards regression model. During a mean follow-up period of 20 months, there were 25 deaths. The estimated cumulative probabilities of survival were 88%, 73% and 58% at 1, 2 and 3 years, respectively. Cox's model identified CAD (P=0.01), NYHA HI class (P=0.04) and LVEF (P=0.02) as independent, statistically significant predictors of mortality. Peak VO2 had only a marginal statistical significance (P=0.07). Age, LVESVI, VT on Holler monitoring and use of antiarrhythmic drugs were not related to mortality. These data can be important in patient clinical management and clinical trial design.
Key Words: Chronic heart failure • prognosis • peak oxygen consumption
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