Predicting death from progressive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy

Leslie A. Saxon, William G. Stevenson, Holly R. Middlekauff, Gregg Fonarow, Mary Woo, Debra Moser, Lynne W. Stevenson

Research output: Contribution to journalArticlepeer-review

166 Scopus citations


Data were retrospectively reviewed on 528 consecutive patients hospitalized for treatment of advanced heart failure (left ventricular ejection fraction 0.2 ± 0.07) and cardiac transplant evaluation, who were stabilized with medical therapy and discharged home. Predictors of heart failure death or rehospitalization for urgent transplantation were identified using the Cox proportional-hazards model. Within 1 year, 59 patients (11%) died suddenly and 70 (13%) died of heart failure or required urgent transplantation. A serum sodium ≤ 134 mEq/liter, pulmonary arterial diastolic pressure >19 mm Hg, left ventricular diastolic dimension index >44 mm/m2, peak oxygen consumption during exercise testing < 11 ml/kg/min and the presence of a permanent pacemaker were independent predictors of hemodynamic deterioration. In the absence of these risk factors the risk of hemodynamic deterioration within 1 year from this study was only 2%. This risk increased to >50% in the presence of hyponatremia and any 2 additional risk factors. Thus, patients with advanced heart failure at highest risk for progressive hemodynamic deterioration can be identified from clinical variables that could aid in triaging such patients to earlier cardiac transplantation.

Original languageEnglish
Pages (from-to)62-65
Number of pages4
JournalAmerican Journal of Cardiology
Issue number1
StatePublished - Jul 1 1993

Bibliographical note

Funding Information:
From the Division of Cardiology, Department of Medicine, University of California Los Angeles Medical Center,L os Angeles, California. Dr. Stevensoni s a Clinician-Scientist of the American Heart Association, Greater Los Angeles Affiliate, Los Angeles, California and is also supported by the Eastern Star Foundation, Los Angeles, California and the Helen Wolfe Estate in memory of Peter D. Wolfe, Los Angeles, California. Manuscript received November 18,1992; revised manuscriptr e-ceived January 28,1993, and acceptedJ anuary 29.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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