Clinical characteristics and factors associated with death from acute decompensated heart failure

Abstract

Aim. To assess the diagnostic significance of clinical indicators and left ventricle ejection fraction (LV EF) for predicting the probability of death from acute decompensated heart failure (ADHF) in patients with chronic heart failure with a reduced LV EF (HFrEF) within one year after implantation of cardioverter defibrillator (ICD).Methods. The study included 384 patients with heart failure NYHA 3-4 functional class with LV EF ≤ 35%, undergoing ICD implantation for the purpose of primary prevention of sudden cardiac death. After ICD implantation the patients included in the study were prospectively observed during one year (visits to the clinic after 3, 6, 12 months). The primary end point - a case of ADHF was registered.Results. In a one-year observation, the primary endpoint was recorded in 38 patients (10 per cent). Single factor logistic regression analysis showed 5 factors with the greatest predictive potential (p<0.1), related to the occurrence of the investigated endpoint. These included: history of arterial hypertension (AH) and obesity, LV EF based on the biplane Simpson’s method, LV EF ≤ 28% and systolic blood pressure. Based on the results of the multi-factor regression analysis, a predictive model was developed, which included three factors with the highest levels of statistical significance: the presence of AH, obesity and LV EF ≤ 28%. The diagnostic efficiency of the model was 69.5% (sensitivity 78.9%; specificity 68.5%).Conclusion. The results of the research indicate that the main predictor of one-year mortality due to ADHF in the studied cohort of HFrEF patients with NYHA class 3-4 is LV EF ≤ 28%. The presence in the history of AH and obesity was associated with the best prognosis for life.