Analysis of deaths in patients awaiting heart transplantation: impact on patient selection criteria.

Haywood, Guy A.; Rickenbacher, Peter; Trindade, Pedro T.; Gullestad, Lars; Jiang, Jeffrey; Schroeder, John S.; Vagelos, Randall H.; Oyer, P E; Fowler, Michael B.

doi:10.1136/hrt.75.5.455

Cited by 35 publications

(8 citation statements)

References 13 publications

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“…As a result, an increasing number of ambulatory patients with advanced CHF are placed on transplant waiting lists. Given the limited number of donor organs, the time on the transplant waiting list has increased and is frequently more than 1 year [2]. On the other hand, Stevenson et al [3] reported that CHF patients who survive on the transplant list for more than 6 months may no longer have a prognostic advantage from cardiac transplantation.…”

Section: Introductionmentioning

confidence: 99%

Risk stratification in middle‐aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two‐variable model

Zugck

Krüger

Kell

et al. 2001

European J of Heart Fail

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Ž. Aims: The performance of a US-American scoring system Heart Failure Survival Score, HFSS was prospectively evaluated Ž . in a sample of ambulatory patients with congestive heart failure CHF . Additionally, it was investigated whether the HFSS Ž . might be simplified by assessment of the distance ambulated during a 6-min walk test 6ЈWT instead of determination of peak Ž . Ž oxygen uptake peak VO . Methods and Results: In 208 middle-aged CHF patients age 54 " 10 years, 82% male, NYHA class 2 . 2.3" 0.7; follow-up 28 " 14 months the seven variables of the HFSS: CHF aetiology; heart rate; mean arterial pressure; Ž . serum sodium concentration; intraventricular conduction time; left ventricular ejection fraction LVEF ; and peak VO , were 2 determined. Additionally, a 6ЈWT was performed. The HFSS allowed discrimination between patients at low, medium and high risk, with mortality rates of 16, 39 and 50%, respectively. However, the prognostic power of the HFSS was not superior to Ž . a two-variable model consisting only of LVEF and peak VO . The areas under the receiver operating curves AUC for 2 Ž . prediction of 1-year survival were even higher for the two-variable model 0.84 vs. 0.74, P -0.05 . Replacing peak VO with 2 Ž . 6ЈWT resulted in a similar AUC 0.83 . Conclusion: The HFSS continued to predict survival when applied to this patient sample. However, the HFSS was inferior to a two-variable model containing only LVEF and either peak VO or 6ЈWT. As the 2 6ЈWT requires no sophisticated equipment, a simplified two-variable model containing only LVEF and 6ЈWT may be more widely applicable, and is therefore recommended. ᮊ

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Section: Introductionmentioning

confidence: 99%

Risk stratification in middle‐aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two‐variable model

Zugck

Krüger

Kell

et al. 2001

European J of Heart Fail

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“…An elevated pulmonary capillary pulmonary pressure was shown to be a poor prognosis in multivariable analyses [14]. Other important parameters directly measured with a PAC that have prognostic information are the RA pressure [15], pulmonary artery pressure [16], and resting cardiac output [17]. The elevated pulmonary artery and RA pressures represent a condition in which the right ventricle function is deteriorating due to elevated left-sided fi lling pressures.…”

Section: Clinical Usementioning

confidence: 98%

Invasive monitoring in patients with heart failure

Husain¹,

Pamboukian²,

Tallaj³

et al. 2009

Curr Cardiol Rep

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The syndrome of heart failure is characterized by symptoms that are relatively insensitive and nonspecific. Physical diagnosis may be unreliable even in the hands of experienced clinicians, despite the presence of significantly elevated filling pressures or a significantly depressed cardiac output. Instrumentation and devices such as the insertion of a pulmonary artery catheter and the implantable hemodynamic monitor have a major role in the diagnosis and management of cardiovascular disease. They provide a means of measuring intracardiac pressures for point-in-time measurements (cardiac catheterization), short term in an acute situation (insertion of a pulmonary arterial catheter), and, more recently, a long-term assessment increasing our understanding of the nuances of the hemodynamic derangements associated with heart failure and other conditions. With improved ability to accurately assess and monitor filling pressures, clinicians can more precisely adjust therapy with the goal of improving patient symptoms and possibly outcomes.

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“…[5][6][7] The high values of PASP were consistent with the presence of CHF, which is associated with an increase in this parameter. [8][9][10] ASP has been shown to be a marker of mortality in CHF. 11,12 The high number of patients with EF >20% and with a DT higher than 130 msec at baseline might have contributed to the reduced morbidity rate throughout the six months of observation.…”

Section: Discussionmentioning

confidence: 99%

BNP and ANP as diagnostic and predictive markers in heart failure with left ventricular systolic dysfunction

Falcão

Pinto

Ravara

et al. 2004

J Renin Angiotensin Aldosterone Syst

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BackgroundThe prevalence of chronic heart failure (CHF) with systolic dysfunction is increasing. Plasma natriuretic peptides have been envisaged as diagnostic and predictive markers. AimsTo investigate the relationship between the levels of B-type natriuretic peptide (BNP) and A-type natriuretic peptide (ANP) and the clinical and functional parameters of CHF in outpatients with CHF at baseline, compared with normal healthy controls; to find out the differences in a randomised controlled trial between patients treated with an angiotensin-converting enzyme (ACE) inhibitor, captopril, or an angiotensin receptor blocker (ARB), irbesartan. These differences were assessed throughout the six-month treatment period and at the sixth month. MethodsPlasma BNP (pmol/L) and ANP (pmol/L) were determined in 68 hypertensive patients with dilated cardiomyopathy, NYHA class III-IV and ejection fraction (EF) <40%, and in 26 normal controls. Statistical analysis for BNP and ANP was done by Student's t-test. The patient group was randomly subdivided into two subgroups of 34 patients, each treated with either an ARB, irbesartan, or an ACE inhibitor (ACE-I), captopril. BNP and ANP were measured in both subsamples and correlated with clinical, functional and neurohormonal parameters throughout a follow-up period of six months and at the sixth month. ResultsThe mean EF in the patient sample was 33.43±6.52% and in the controls was 61.96 ±3.53% (p=0.000). The mean BNP (pmol/L) in patients was 44.78±54.36 and in the controls was 7.12±8.28 (p=0.000) and the mean ANP (pmol/L) was 30.32±25.97 in patients and 11.18±7.92 in controls (p=0.000). A statistically significant difference was found between patients and healthy controls. Significant correlations were found between natriuretic peptides and EF. Between the baseline phase and the sixth month, BNP and ANP decreased significantly in the ARB group. At the sixth month, both BNP and ANP were lower in the ARB group. Evidence of clinical benefit was found with both ARB or ACE-I treatment throughout the six months, with patients moving from classes III and IV to class II NYHA. Improvement of EF was also found, with transition of patients with lower EF (even <30%) to higher values. EF was higher in the ARB group at the sixth month. ConclusionsBNP and ANP can be useful diagnostic tools in hypertensive CHF patients with moderate-to-severe LV dysfunction. The decrease in BNP and ANP in the ARB group throughout six months, as well as the lower value at the sixth month, suggest a prognostic value of these parameters.

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Analysis of deaths in patients awaiting heart transplantation: impact on patient selection criteria.

Abstract: (Heart 1996;75:455-462)

Cited by 35 publications

References 13 publications

Risk stratification in middle‐aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two‐variable model

Risk stratification in middle‐aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two‐variable model

Invasive monitoring in patients with heart failure

BNP and ANP as diagnostic and predictive markers in heart failure with left ventricular systolic dysfunction

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