Heart failure and systolic function: time to leave diagnostics based on ejection fraction?
Otto A. Smiseth, John M. Aalen, Helge Skulstad
Abstract
(A and B) Prediction of 1-year mortality by LVEF measured during rest (A) and by maximum cardiac power during dobutamine stress (B) in patients with severe acute or chronic heart failure. Means ± SD. For LVEF, there is considerable overlap, whereas maximum cardiac power differentiates well between survivors and non-survivors. An open circle indicates cardiac transplanted and open squares indicate sudden deaths. Modified from Tan.8 (C) Data from the SHOCK Trial Registry showing that cardiac power was a strong predictor of mortality in cardiogenic shock. Modified from Fincke et al.9 (D) Five-year mortality was similar in heart failure patients with preserved, borderline, and reduced ejection fraction. Modified from Shah et al.10 (E) Illustration of a patient during stress echocardiography with a semi-supine bicycle. (F) Five-year Kaplan–Meier survival curves for mortality stratified by quartiles of peak stress cardiac power/mass. Patients with the lowest cardiac power/mass in quartile 1 had the worst survival followed by quartiles 2 and 3, and was the best in quartile 4. Adjusted for age, sex, peak metabolic equivalents, diabetes mellitus, and diastolic function at baseline. Reproduced from Anand et al.1