Abstract
Aims: The prognostic value of different clinical, echocardiographic and functional parameters was evaluated in clinically stable outpatients with heart failure due to idiopathic dilated cardiomyopathy (DCM). Study Design: Observational prospective study. Methodology: 56 patients suffering from idiopathic dilated cardiomyopathy in waiting list for heart transplantation (33 men and 23 women, mean age 56.4 years) and in clinical stab le conditions for a minimum of 3 months underwent baseline clinical evaluation, echocardiogram, 6 minute walk test (6 MWT) and cardiopulmonary exercise test (CPET). They were followed for an average period of 26.5 months to assess event free survival (dea th, heart transplantation). Results: During follow-up period 23 patients died, 21 for cardiovascular causes. 4 patients underwent heart transplantation. Age and sex were not related to survival. We found a significant predictive value for 6MWTD (at 1 year event-free survival was 53% for a distance <300 m), but not for VO2peak or respectively anaerobic threshold (AT). At multivariate analysis using Cox-stepwise regression model NYHA class, 6MWTD, left ventricular ejection fraction and left ventricular end diastolic diameter were independent prognostic markers of survival. Conclusion: An advanced NYHA class, a higher LVEDD and a distance of < 300m at 6MWT are useful prognostic markers of event free survival in outpatients with stable DCM while CPET was not. Research Article
Highlights
Several studies have supported the value of cardiopulmonary exercise test (CPET) in functional evaluation of patients with heart failure and peak oxygen consumption (VO2 peak) has been reported as the most sensitive independent prognostic index of survival (Cohn and Rector, 1988; Pilote et al, 1989)
The difference among groups was already significant at 12 months, at 36 months event free survival was 53% in patients with 6MWD < 300 m, in comparison to 72% and respectively 92% in the other two groups
A VO2 peak above 20 ml/kg/min was associated with a good prognosis
Summary
Several studies have supported the value of cardiopulmonary exercise test (CPET) in functional evaluation of patients with heart failure and peak oxygen consumption (VO2 peak) has been reported as the most sensitive independent prognostic index of survival (Cohn and Rector, 1988; Pilote et al, 1989). The prognostic usefulness of 6MWT was first reported by Bittner et al (1993) in patients included in the Studies of Left Ventricular Dysfunction (SOLVD) Trial and subsequently confirmed by other authors both in patients with moderate (NYHA II-III class) or severe heart failure of different etiologies (mainly coronary artery disease) undergoing evaluation for heart transplantation (Lipkin et al, 1986; Lucas et al, 1999; Rostagno et al, 2003 ), accuracy of 6MWT to predict mortality in advanced heart failure was not confirmed by other authors (Aaronson, 1999).
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