Clinical evaluation of heart failure: agreement among tests (648.4)

Abstract

Congestive heart failure (CHF) is the most common cause of nonelective hospitalization of subjects over the age of 65 in the US. CHF clinical status is evaluated by ejection fraction (EF), symptoms, and exercise tolerance. Although difficult to apply clinically, a gold standard of left ventricular (LV) function is the rate of LV pressure development (+dP/dt). We tested the hypothesis that EF, symptoms, and exercise treadmill test (ETT) duration would correlate with each other and with +dP/dt. Subjects with symptomatic CHF (62 ± 2 yo; EF 30 ± 2%; n = 27) underwent measurement of EF, symptoms (Kansas City Cardiomyopathy Questionnaire Score, KCCQS), ETT duration, and +dP/dt (via cardiac catheterization). EF and +dP/dt were measured before and during dobutamine infusion. Results were compared using Pearson’s correlation analysis. Overall, tests correlated poorly. The only significant correlations were between KCCQS and +dP/dt. KCCQS correlated with both basal +dP/dt (r = ‐0.47, p = 0.021) and stimulated +dP/dt (r = ‐0.63, p < 0.001). KCCQS and stimulated +dP/dt were correlated regardless of ischemic (r = ‐0.69, p = 0.026) or non‐ischemic etiology (r = ‐0.56, p = 0.038).Conclusion: EF, ETT, and symptoms are not correlated in CHF patients. Using +dP/dt as a gold standard, EF and ETT do not correlate as well with LV function as symptoms do. EF and ETT may be less effective measures of LV function than commonly believed.Grant Funding Source: Supported by National Institutes of Health grants (P01 HL66941, HL088426, HL081741, and HL107200)