Clinical prognosis for 12 months and its predictors in patients with chronic heart failure and a reduced left ventricular ejection fraction
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Abstract
The aim – to establish and determine the limiting values of clinical and instrumental parameters associated with the development of adverse cardiovascular events (death or hospitalization) in patients with chronic heart failure (CHF) and left ventricular ejection fraction (LVEF) ≤ 35 % at 12-month follow-up.
Materials and methods. 120 hemodynamically stable patients, 18–75 years of age, with CHF, II–IV NYHA functional class, LVEF ≤ 35 % were examined. Patients were included in the study in the phase of clinical compensation. The endpoint was combined and defined as the time until the first hospitalization in connection with decompensation of CHF or death. The observation period was 12 months, the mean time before the onset of the combined critical point (CCP) was 8.67 months. The search for the limit values of the predictors was carried out using cluster analysis with two variables.
Results and discussion. According to the results of the cluster analysis, the informative predictors of achieving a combined endpoint in patients with CHF within 12 months are the number of kilograms lost over the previous 6 months > 4.5 kg or body weight loss > 6.03 %, shoulder circumference of an unstrained arm ≤ 32.5 cm, strained arm ≤ 35 cm, hips ≤ 50 cm, cutaneous fat fold thickness above triceps ≤ 24 mm and in the inguinal region ≤ 8.5 mm, percentage of cutaneous fat mass ≤ 16.7 %, limb muscle mass index ≤ 8.96 kg/m2, BMI ≤ 31.2 kg/m2, C-reactive protein > 4.52 mg/ml, blood cholesterol ≤ 4.5 mmol/l, flow-dependent vasodilation result ≤ 9.09 %, TAPSE ≤ 11mm and the relation of TAPSE to pulmonary artery systolic pressure (PASP) ≤ 0.27, the total score for the Minnesota questionnaire > 61 points, according to the DEFS scale > 22 points, according to Duke University questionnaire ≤ 8.575 points, test with 6-minute walk ≤ 255m and test with extension of the lower limb ≤ 22.
Conclusions. The results of measuring anthropometric indicators reflecting the nutritional status of patients with CHF have an advantage over the results of densitometric determination of tissue components of the body in stratification of their long-term clinical risk.
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