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Predictors of Mortality and Hospitalization for Cardiac Causes in Patients with Heart Failure and Nonischemic Heart Disease: A Subanalysis of the ALPHA Study |
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| Authors: | MATTEO ANSELMINO MD GAETANO M DE FERRARI MD † RICCARDO MASSA MD LORENZO MANCA MD ‡ MASSIMO TRITTO MD § GIULIO MOLON MD ¶ ANTONIO CURNIS MD # PAOLO DEVECCHI MD SIMONA SARZI BRAGA MD †† GIORGIO BARTESAGHI‡‡ CATHERINE KLERSY MD §§ FRANCESCO ACCARDI¶¶ JORGE A SALERNO-URIARTE MD ‡‡ for the ALPHA Study Group Investigators |
| Institution: | From the Universitàdegli Studi di Torino, Divisione Universitaria di Cardiologia, Azienda Ospedaliera San Giovanni Battista, Torino, Italy;;Dipartimento di Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;;Divisione di Cardiologia, Presidio Ospedaliero F. Ferrari, Casarano (LE), Italy;;Laboratorio di Elettrofisiologia, Dipartimento di Cardiologia, Istituto Clinico Mater Domini, Castellanza (VA), Italy;;Divisione di Cardiologia, Ospedale Sacro Cuore, Negrar (VR), Italy;;Universitàdegli Studi di Brescia, UnitàOperativa di Cardiologia, Spedali Civili, Brescia, Italy;;Universitàdegli Studi del Piemonte Orientale, 1°Divisione di Cardiologia, Ospedale Maggiore, Novara, Italy;;Divisione di Cardiologia, IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico, Tradate (VA), Italy;;Universitàdegli Studi dell'Insubria, Dipartimento di Scienze Cardiovascolari, Ospedale di Circolo e Fondazione Macchi, Varese, Italy;;Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;;and Dipartimento Clinico Guidant Italia (Boston Scientific Corporation), Milano, Italy |
| Abstract: | Background: Several studies have searched for predictors of clinical outcome in patients with heart failure (HF). However, since they were collected in clinical trials, most data were subject to selection biases and do not specifically apply to patients with nonischemic heart disease. This study examined the impact of several variables on combined all-cause mortality and hospitalization for cardiac causes, in consecutive ambulatory patients with HF included in the ALPHA registry. Methods and Results: This analysis included 446 patients with HF and nonischemic heart disease, in New York Heart Association functional class II or III, and a left ventricular (LV) ejection fraction below 40%. In 126 patients (73%) the disease was idiopathic dilated cardiomyopathy, in 72 (16%) hypertensive, in nine (2%) valvular, and in 39 (9%) of other etiologies. The median age was 61 years (range 51–69 years) and 349 (78%) patients were men. Over a median follow-up of 31 months (range 23–40), 82 patients (18%) died or were hospitalized for cardiac causes. In a proportional hazard (Cox) regression model, maximal oxygen consumption (HR 0.9, P = 0.001), LV end-diastolic diameter (HR 1.07, P < 0.001), resting systolic blood pressure (HR 0.97, P < 0.005), and hemoglobin (HR 0.86, P < 0.05) were independent predictors of the combined study endpoint. Conclusions: In an unselected population of patients with HF and nonischemic heart disease, a reduced exercise capacity, large LV end-diastolic diameter, low systolic blood pressure, and hemoglobin were correlated with long-term all-cause mortality or hospitalization for cardiac causes. These observations may help stratifying and tailoring the treatment of patients with HF and nonischemic heart disease. |
| Keywords: | heart failure nonischemic heart disease dilated cardiomyopathy survival analysis predictor analysis |