Heart Failure Patients with Preserved Left Ventricular Systolic Function Have 5-Year Mortality Rate of 25%

Patients with clinical heart failure who also have impaired left ventricular systolic function have a significantly greater mortality risk than those with preserved left ventricular systolic function. But those with preserved function still have a 5-year mortality rate of 25%.

Mark T. Kearney, a senior lecturer at Guy’s, King’s, and St. Thomas’s School of Medicine, in London, United Kingdom, and colleagues analysed 5-year mortality rates in a cohort of ambulant patients with stable, symptomatic chronic heart failure for at least 3 months and evidence of cardiac dysfunction.

The 359 patients with ejection fraction less than 50% were characterised with impaired left ventricular systolic function and were compared with the 163 patients with preserved left ventricular systolic function (ejection fraction 50% or greater).

Those with preserved function were a mean age of 62.5 years old and 117 were men, while the patients with impaired function had a mean age of 62.3 years and 287 were men.

The 5-year mortality rate was 41.5% in the cohort with impaired left ventricular systolic function, which is significantly greater than the 25% 5-year mortality rate of the preserved function cohort.

All patients underwent 24-hour ambulatory monitoring for arrhythmia analysis and heart rate variability assessments to determine a global index of total heart rate variability, which were similar between the study groups.

The researchers report abnormal autonomic function in both groups, which, coupled with a 25% rate of non-sustained ventricular tachycardia and a 12% rate of left ventricular hypertrophy, may be contributory to the high mortality found in the patients with preserved function, they write.

The researchers conclude, “established treatments for systolic heart failure may also have a role in patients with chronic heart failure and preserved left ventricular systolic function.”

BMJ 2003;327:78-9.