July 13, 2007
View Full PaperEjection Fraction and Blood Pressure are Important and Interactive Predictors of 4-Week Mortality in Severe Acute Heart Failure
Key Result
Lower LVEF (OR 1.27 per 10% decrease; 95% CI 1.05-1.53) and lower MAP were independent predictors of 4-week mortality in severe acute heart failure, with LVEF risk amplified at MAP ≤90 mmHg.
Study Design
Type
Cohort (n=355)
Multicenter
Yes
Structured PICO
Do LVEF and MAP independently predict 4-week mortality in patients with severe acute heart failure?
P
Population
355 patients with severe acute heart failure syndromes admitted to CCU/ICUs with available echocardiographic LVEF, followed for 4 weeks.
E
Exposure
Assessment of left ventricular ejection fraction (LVEF) and mean arterial pressure (MAP)
O
Outcome
4-week mortalityhard clinical
LVEF and MAP are interactive predictors of 4-week mortality in severe acute heart failure, with LVEF offering significant prognostic value primarily when MAP is ≤90 mmHg.
Main Result
Odds Ratio: 1.27 (95% CI 1.05–1.53)
p-value: p=0.012
Abstract
BACKGROUND: In acute heart failure syndromes (AHFS), the prognostic value of left ventricular ejection fraction (LVEF), although widely accepted, has been recently challenged. In contrast, blood pressure is increasingly gaining ground over LVEF as predictor of mortality. Therefore, it is not clear whether both LVEF and mean arterial pressure (MAP) are independent risk factors in patients with AHFS. METHODS AND RESULTS: The EFICA study enrolled 581 AHFS patients admitted to 60 CCU/ICUs. Survival at 4 weeks was analyzed for all cases with echocardiographic LVEF available on admission (n=355). Four-week mortality was 23%. Multivariable analysis identified lower LVEF, lower MAP and serum creatinine >1.5 mg/dl as independent correlates of mortality (respectively, OR: 1.27 per 10% decrease, CI: 1.05-1.53, p=0.012; OR: 1.30 per 10 mmHg decrease, CI: 1.15-1.48, p90 mmHg. CONCLUSIONS: Both LVEF and MAP are important predictors of death in severe AHFS. LVEF can provide additional prognostic information on top of MAP but mainly in patients with low MAP (<or=90 mmHg) at admission.