1. Incremental prognostic value of exercise hemodynamic variables in chronic congestive heart failure secondary to coronary artery disease or to dilated cardiomyopathy.
- Author
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Griffin BP, Shah PK, Ferguson J, and Rubin SA
- Subjects
- Blood Pressure physiology, California epidemiology, Carbon Dioxide metabolism, Cardiac Output physiology, Cardiomyopathy, Dilated physiopathology, Chronic Disease, Coronary Disease physiopathology, Female, Follow-Up Studies, Heart Failure etiology, Heart Failure mortality, Heart Rate physiology, Humans, Male, Middle Aged, Oxygen Consumption physiology, Prognosis, Prospective Studies, Pulmonary Wedge Pressure physiology, ROC Curve, Rest, Stroke Volume physiology, Survival Rate, Ventricular Function, Left physiology, Cardiomyopathy, Dilated complications, Coronary Disease complications, Exercise Test statistics & numerical data, Heart Failure physiopathology, Hemodynamics physiology
- Abstract
To determine the prognostic value of hemodynamic variables at rest and during exercise, 49 patients with chronic congestive heart failure undergoing hemodynamic evaluation at rest and during symptom-limited exercise were followed for 1 year. One-year mortality rate was 33%. On univariate analysis, nonsurvivors differed significantly from survivors in pulmonary arterial wedge pressure at rest (22 +/- 10 vs 15 +/- 10 mm Hg; p = 0.01) and during exercise (32 +/- 9 vs 24 +/- 9 mm Hg; p = 0.003), stroke work index at rest (19 +/- 6 vs 25 +/- 9 g-m/m2; p = 0.03) and during exercise (20 +/- 7 vs 32 +/- 14 g-m/m2; p = 0.001) and exercise-induced increment in stroke work index (0.5 +/- 0.4 vs 7 +/- 8 g-m/m2; p = 0.004), but not with respect to left ventricular ejection fraction, exercise duration, peak oxygen consumption or peak left ventricular hydraulic power. Patients with a peak exercise stroke work index less than 20 g-m/m2 had a 66% mortality rate compared with a mortality rate of 13% in patients with a peak exercise stroke work index greater than 20 g-m/m2 (p = 0.0001). Multiple logistic regression analysis identified pulmonary arterial wedge pressure at rest and peak exercise stroke work index as the only independent predictors of mortality. A receiver-operating characteristic curve analysis revealed that peak exercise stroke work index provided significant incremental prognostic information over the resting hemodynamic variables.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1991
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