Clinical History Of Heart Failure Research Articles

Prognostic value of congestive heart failure history in patients undergoing percutaneous coronary interventions

Objectives. We sought to determine the prognostic significance of a history of congestive heart failure above that provided by baseline ejection fraction in patients undergoing percutaneous coronary interventions.Background. Left ventricular function is a known predictor of survival in patients with coronary artery disease, as is a history of congestive heart failure. The contribution of heart failure history independent of left ventricular function is unknown.Methods. Data were pooled from four interventional trials and the Duke University database. The combined dataset included 5,260 patients undergoing percutaneous interventions, 334 with and 4,926 without a history of heart failure. Patients were defined by the treating physician as having a clinical history of heart failure at the time of enrollment.Results. The 30-day and 6-month mortality were higher in patients with a clinical history of congestive heart failure than in those without such a history (2% vs. <1%, p = 0.002 at 30 days, 5% vs. 1%, p = 0.001 at 6 months). Heart failure history did not influence the incidence of myocardial infarction, use of angioplasty or the use of bypass surgery during follow-up. Multivariable analysis revealed that heart failure history added significantly to ejection fraction in predicting intermediate-term (6-month) mortality (p = 0.01). Stepwise logistic regression also revealed heart failure history to be an independent predictor of 6-month mortality (odds risk 1.9, 95% confidence interval 1.1 to 3.5).Conclusions. A clinical history of congestive heart failure is associated with increased early and intermediate-term mortality in patients undergoing percutaneous revascularization. Congestive heart failure history appears to provide prognostic information independent of that available from a patient’s left ventricular function. These findings suggest that patients with a clinical history of congestive heart failure who undergo a percutaneous intervention should be closely monitored, especially those with the lowest ejection fractions.

Left ventricular function and endomyocardial biopsy in early and advanced dilated cardiomyopathy

We evaluated left ventricular function and endomyocardial biopsy in 20 patients with early and advanced dilated cardiomyopathy, with the purpose of assessing the correlation between histologic variables and systolic and diastolic filling indexes. Group 1 included 10 patients with no clinical history of heart failure and left ventricular ejection fraction ≥45% and group 2, 10 patients with a clinical history of heart failure and left ventricular ejection fraction <45%. Group 1 showed lower left ventricular end-systolic and end-diastolic volumes indexes (49±14 versus 86±23 ml/m 2, P<0.001; 98±25 versus 127±35 ml/m 2, P=0.049), higher left ventricular ejection fraction (50±4 versus 32±4%, P<0.001) and lower coefficient of variation of percentage shortening of left ventricular transverse hemiaxes (0.3±0.1 versus 0.5±0.1, P=0.001) compared with group 2. Group 1 had higher A wave peak velocity (78±18 versus 60±20 cm/s, P=0.048), lower E/A ratio (0.9±0.3 versus 1.5±0.6, P=0.02) and slower E wave deceleration time (204±51 versus 155±50 ms, P=0.047) compared with group 2. Semiquantitative histologic scores did not differ significantly between groups. There was no significant correlation between histologic variables and left ventricular systolic and diastolic indexes. Thus, dilated cardiomyopathy shows borderline to severe left ventricular systolic impairment and distinct left ventricular diastolic filling abnormalities, according to the clinical stage. This study suggests a marked dissociation between histologic findings and functional abnormalities in early and advanced dilated cardiomyopathy.

Changes in hemodynamics due to the contrast medium during left ventriculography.

Seventeen patients with heart diseases examined by left ventricular angiography were divided into two groups consisting of those with a clinical history of heart failure (CHF+) and those without (CHF-). Changes in hemodynamics, circulating blood volume, and plasma volume due to injection of the contrast medium were studied, and the following results were obtained. Both the CHF- and CHF+ groups showed an increase in heart rate after injection of the contrast medium, but a statistically significant difference (p less than 0.05) was noted only at one and two minutes after angiography in both groups. Left ventricular systolic pressure decreased after injection of the contrast medium in both groups, but the CHF+ group required a longer time for recovery. In the CHF- group, the left ventricular end-diastolic pressure increased slightly after injection of the contrast medium, but in the CHF+ group it increased markedly with a statistically significant difference (p less than 0.01). Stroke volume, measured by a noninvasive, continuous cardiac output monitor according to the impedance method, increased upon injection of the contrast medium in the CHF- group. However, in the CHF+ group it decreased, although no statistically significant difference was noted in either group. Cardiac index increased markedly upon injection of the contrast medium in the CHF- group with a statistically significant difference (p less than 0.01), but hardly any change was observed in the CHF+ group.(ABSTRACT TRUNCATED AT 250 WORDS)