Abstract

SOLIS OLIVARES, Carlos Alberto; JERJES-SANCHEZ DIAZ, Carlos  and  ARCHONDO ARCE, Tamara. Prognosis of systolic left ventricular dysfunction. Arch. Cardiol. Méx. [online]. 2003, vol.73, n.3, pp.197-204. ISSN 1665-1731.

Background: Our current knowledge on the prognosis of systolic left ventricular dysfunction has been obtained through multicentric trials performed at third level health care institutions, which usually include patients based on strict inclusion criteria. Objective: To establish in systolic left ventricular dysfunction patients, evaluated at a community hospital, a risk profile for adverse cardiovascular events and to know their survival. Methods: Prospective study with 4 years follow-up. Inclusion criteria: a) Symptomatic patients with systolic left ventricular dysfunction, b) any NYHA functional class or etiology, c) ejection fraction < 40%. Exclusion criteria: a) Asymptomatic patients, b) acute coronary syndrome in the last 6 weeks, c) ventricular dysfunction secondary to pulmonary arterial hypertension, d) severe systemic illness or neoplasms causing disability < 6 months. Statistics: Student's t test, Chi-square, Yates and Mantel-Haenszel. Unvariant and multivariant logistic regression analysis. Cox and Kaplan-Meier method. Significance was set at p < 0.05. Results: From January 1997 to January 2001, 110 patients were studied, 61% men and 39% women, their age were 61 ± 13.1 years. Ischemic etiology in 46% and 54%, 68% in III/IV NYHA class and 32% in I/II NYHA class. Basal left ventricular ejection fraction was 28 ± 6.9%. Patients were followed for 30.11 ± 18.7 months, with 26% of global mortality. Through lineal, logistic and multivariate regression analysis, the high clinical risk profile was identified, corresponding > 65 years, female gender, hypertension, diabetes mellitus II, ischemic heart disease, III/IV NYHA class and ventricular tachycardia (p = 0.00001). Conclusion: In the "real world" of systolic left ventricular dysfunction, the identified risk profile allows stratify high priority subgroup of patients to be enrolled in a cardiac transplant program. (Arch Cardiol Mex 2003; 73:197-204).

Keywords : Systolic left ventricular dysfunction; Acute coronary syndromes; Acute myocardial infarction.