A number of simple clinical and laboratory variables were analysed in a group of patients with chronic heart failure to evaluate their prognostic significance. Five hundred and fifty-two patients were followed for a maximum of 13 years with a total exposure time to death or censored survival of 1148 years. Of the clinical variables, diuretic dose and NYHA class were related to mortality (P < 0.01), and ischaemic heart disease was associated with a worse prognosis than other aetiologies (P < 0.05). Of the laboratory variables, abnormalities of liver function tests including bilirubin (P < 0.01), aspartate transaminase (P < 0.005), gamma glutamyl transpeptidase (P < 0.005) and alkaline phosphatase (P < 0.01) were all related to mortality as was plasma urate (P < 0.01). Multivariate survival analysis of all variables showed aspartate transaminase (chi 2 17.36, P < 0.001) accounted for the greatest variance followed by serum bilirubin (chi 2 14.35, P < 0.005). Thus, abnormalities in liver function tests have prognostic importance in chronic heart failure.

We compared the cardiovascular, glucose, insulin, and catecholamine responses to high-fat (F) and high-carbohydrate (C) meals in healthy young subjects (mean age 23 yr, range 19-39). Cardiac output rose 30 min after C by 32% [95% confidence interval (CI) of the increase +0.32 to +1.64 l/min] and after F by 22% [95% CI +0.30 to +1.96 l/min; P = 0.03, analysis of variance (ANOVA)]. Superior mesenteric artery blood flow rose by 87% 15 min after C (95% CI +119 to +258 ml/min) and by 122% (95% CI +138 to +392 ml/min) 45 min after F, with significantly different patterns of response (interaction effect P less than 0.05, ANOVA). Calf blood flow fell and remained low for 60 min after F but only fell 15 min after C, with a return to fasting levels thereafter (interaction effect P less than 0.03, ANOVA). Thirty minutes postprandially the change of calf blood flow from baseline after C was significantly different than after F (95% CI of differences +0.1 to +2.04 ml.100 ml-1.min-1). Glucose, insulin, and norepinephrine levels increased more after C than after F. Thus there are different regional vascular responses to C and F despite similar cardiac output increases.

The central and peripheral haemodynamic effects of a modest meal were investigated in healthy volunteers at rest and in response to submaximal exercise. The meal increased heart rate, cardiac output, oxygen consumption, carbon dioxide production, and minute ventilation at rest and during exercise. The effects of food were additive to those induced by the exercise. Food had no effect on limb blood flow and lowered total systemic vascular resistance suggesting that there were no compensatory changes in regional blood flow to help redirect blood to the gut.An increase in cardiac output, and therefore myocardial work, is the predominant cardiovascular response to eating and this may help explain the postprandial deterioration in symptoms of some patients with cardiovascular disorders.

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