Factors influencing survival and mode of death in severe chronic ischaemic cardiac failure.

Abstract

SUMMARY An evaluation of factors which may influence survival and mode of death was conducted over a three year period in a consecutive series of 50 patients with severe chronic ischaemic cardiac failure for more than three months. At the initial assessment all patients were already receiving intensive medical treatment. During follow up four patients successfully underwent cardiac surgery and medical treatment was modified in most patients, with four patients receiving antiarrhythmic drugs. Twenty six patients died: 17 suddenly within one hour of onset of symptoms and nine of progressive cardiac failure. The mortality by one year was 26% and by two years it was 62%. Comparison of those who survived with those who died within one year of follow up showed that a very low left ventricular ejection fraction, severe ventricular arrhythmias, the presence of gallop rhythm, and New York Heart Association class IV were the variables that predicted mortality. By two years left ventricular ejection fraction, ventricular arrhythmias, and pulmonary capillary wedge pressure were the variables that were significantly different in survivors and patients who died. No differences were found in' any of the recorded variables between those who died suddenly and those who did not.Thus in patients with chronic ischaemic cardiac failure determination of the left ventricular ejection fraction and the severity of ventricular arrhythmia on the ambulatory electrocardiogram are the best ways to predict prognosis. The presence of gallop rhythm and New York Heart Association class IV status predict early death.

Effect of Propafenone on the Contractile Activity of Latissimus Dorsi Muscle Isolated in an Organ Chamber: Experimental Study in Rats

“…Left ventricular ejection fraction is one of the major predictors of survival in the analysis of heart disorders, and its drop results from cardiac dilation 19,32,33 . Some studies showed the efficacy in generating systolic force by surrounding the heart with muscular flaps 11,14 .…”

The third heart sound for diagnosis of acute heart failure

“…Another study also found that the detection of an S3 has a high specificity and positive predictive value in detection of patients with low EFs [45]. Even more importantly, it has been suggested that patients with a detectable S3 have an increased risk of hospitalization and death compared with those patients without a detectable S3 [46][47][48].…”

The effect of treatment on survival in congestive heart failure

“…19 In another l-year, follow-up study of 69 patients with nonischemic dilated cardiomyopathy, ventricular arrhythmias were predictive of mortality with the highest mortality rates among those patients with the most severe arrhythmia^.^^ In a group of 62 patients with chronic CHF, those evidencing ventricular arrhythmias during baseline exercise testing had significantly lower 2-year survival rates than those who did not develop ventricular arrhythmias. "…”

“…Ventricular arrhythmias have been found in as many as 70% to 80% of patients with CHF and certain types and frequencies of ventricular arrhythmias have been shown to predict total mortality in heart failure?+ 19,29 In a study of 50 patients with chronic ischemic cardiac failure, mortality was highest in patients with serious ventricular arrhythmias on ambulatory electrocardiograms during both 1 -and 2-year follow-up periods. 19 In another l-year, follow-up study of 69 patients with nonischemic dilated cardiomyopathy, ventricular arrhythmias were predictive of mortality with the highest mortality rates among those patients with the most severe arrhythmia^.^^ In a group of 62 patients with chronic CHF, those evidencing ventricular arrhythmias during baseline exercise testing had significantly lower 2-year survival rates than those who did not develop ventricular arrhythmias.…”

“…In another study enrolling 295 patients with mildto-moderate CHF, exercise time was significantly associated with total mortality (p = .005), but not with sudden low-up. 19 death. 16 It is interesting that in the V-Hem I1 trial, the combination of hydralazine and isosorbide dinitrate significantly improved exercise performance (p c .05), while enalapril did not, but enalapril increased survival significantly more than the hydralazindisosorbide dinitrate combination (p = ,016) ' Although VO2 has been found to be a predictor of mortality in patients with CHF, this variable does not necessarily correlate well with other prognostic variable^.…”