Different prognostic relevance of left ventricular volumes and ejection fraction in heart failure patients with ischernic or non ischemic aetiology: A meta analysis

Abstract

Background: A reduced left ventricular (LV) ejection fraction (EF) is considered an indicator of poor prognosis in heart failure (HF) patients. However, the predictive power of other commonly used echocardiographic indicators such as a restrictive LV filling pattern (RFP), enddiastolic (EDV) and end-systolic (ESV) LV volumes is still incompletely defined. Aim. The aim of this analysis was to assess the prognostic relevance of echocardiographically derived EDV and ESV, EF and RFP in HF patients with either ischemic or non ischemic aetiology. Methods. A meta-analysis was performed merging into a single database the individual patient data (demographic, clinical, echo and outcome) of 18 prospective studies investigating the relationship between echocardiographic LV dysfunction and prognosis in HF patients in sinus rhythm. This analysis included 1672 patients with LV volume measurements (mean age 59.6 years, 1331 males); 368 deaths occurred during a median follow-up period of 27.8 months. Results. A RFP (HR 2.11, 95%CI 1.60-2.76, χ 2 p<0.0001), EF (for each unit, HR 0.96, 95%CI 0.94-0.98, χ 2 p<0.0001) and age (for each year, HR 1.04, CI, 1.03-1.06, χ 2 p<0.0001) turned out to be independent predictors of death in ischemic patients. A RFP (HR 3.11, 95%CI 2.07-4.67, χ 2 p<0.0001), ESV (for each ml, HR 1.002, 95%CI 1.001-1.004, χ 2 p=0.0004) and age (for each year, HR 1.03, 95%CI 1.01-1.04, χ 2 p=0.008) were independent predictors of death in non ischemic patients. Conclusions. In HF patients, a restrictive LV filling pattern is the strongest indicator of poor prognosis, irrespective of aetiology. Additional prognostic information is provided either by ESV in non ischemic patients or by EF in ischemic patients