CHRONIC CONGESTIVE-HEART-FAILURE - DESCRIPTION AND SURVIVAL OF 190 CONSECUTIVE PATIENTS WITH A DIAGNOSIS OF CHRONIC CONGESTIVE-HEART-FAILURE BASED ON CLINICAL SIGNS AND SYMPTOMS
CHRONIC CONGESTIVE-HEART-FAILURE - DESCRIPTION AND SURVIVAL OF 190 CONSECUTIVE PATIENTS WITH A DIAGNOSIS OF CHRONIC CONGESTIVE-HEART-FAILURE BASED ON CLINICAL SIGNS AND SYMPTOMS
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DOI：
10.1093/oxfordjournals.eurheartj.a060495
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发表时间：
1994-03-01
影响因子：
39.3
通讯作者：
MORTENSEN, LS
中科院分区：
文献类型：
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作者：
MADSEN, BK;HANSEN, JF;MORTENSEN, LS
对190例76岁以下（平均64岁）充血性心力衰竭（CHF）患者的预后和与预后相关的临床表现进行了研究。CHF的病因为缺血性心脏病（66%）、高血压（11%）和心肌病（23%）。2年死亡率为32%。中位左心室射血分数（LVEF）为0.30，范围为0.06至0.74。纽约心脏协会（NYHA）I级8%，II级46%，III级44%，IV级2%。排除运动试验变量，多变量分析显示7个变量具有独立的、重要的预后信息，（括号内为死亡风险比）：In（自然对数）（LVEF）（3.19），NYHA III+IV级（2.72），血浆尿素> 7.6 mmol。1−1（2·22），血清肌酐>121 μmol。1−1（2·05），血清钠<137 mmol。1 - 1（2·03），X线肺充血（1·86），年龄>65岁（1·86）。包括运动试验在内的多变量分析显示，以下变量包含独立的、重要的预后信息：最大运动时心率增加≤35 min−1（3.5），In（LVEF）（3.7），血清肌酐>121 μmol。1 - 1（2·9），最大运动时间≤4 min（2·3），血钠137 mmol。1−1（2.5），缺血性心脏病（2.0）和血浆尿素> 7.6 mmol。1−1（19）.总之，CHF患者尽管接受了强化治疗，但死亡风险很高。LVEF是死亡率的强预测因子。NYHA心功能分级和运动变量与LVEF结合，在死亡率方面具有很强的独立预后信息，但相互排斥。
The prognosis, and clinical findings related to prognosis, were examined in a consecutive series of 190 patients under 76 years of age (mean 64 years) with congestive heart failure (CHF). The aetiology of CHF was ischaemic heart disease in 66%, hypertension in 11% and cardiomyopathy in 23%. The 2-year mortality was 32%. Median left ventricular ejection fraction (LVEF) was 0·30, range 0·06 to 0·74. Eight per cent were in New York Heart Association (NYHA) class I, 46% in II, 44% in III and 2% in IV.Multivariate analysis, excluding exercise test variables, revealed seven variables with independent, significant prognostic information, (hazard ratios for death in brackets): In (natural logarithm) (LVEF) (3·19), NYHA class III+IV (2·72), plasma urea>7·6 mmol. 1−1(2·22), serum creatinine >121 μmol. 1−1(2·05), serum sodium <137 mmol. 1−1(2·03), pulmonary congestion on X- ray (1·86), and age >65 years (1·86). Multivariate analysis, including exercise testing, showed the following variables to contain independent, significant prognostic information: increase in heart rate during maximal exercise ≤35 min−1(3·5), In(LVEF) (3·7), serum creatinine >121 μmol. 1−1(2·9), maximal exercise time ≤4 min (2·3), serum sodium 137 mmol. 1−1(2·5), ischaemic heart disease (2·0) and plasma urea >7·6 mmol. 1−1(19).In conclusion, patients with CHF have a high risk of death despite intensive medical treatment. LVEF is a strong predictor of mortality. Both NYHA class and exercise variables have strong independent prognostic information as regards mortality in combination with LVEF, but are mutually exclusive.