HEART-FAILURE PROGRESSION DUE TO SECONDARY ORGAN DYSFUNCTION IN ACUTEHEART-FAILURE

Although the pathophysiology of heart failure progression is important to survival it is not fully understood. In 92 patients with acute hea rt failure due to myocardial infarction or dilated cardiomyopathy, sec ondary organ dysfunction was evaluated to determine whether this facto r contributed to heart failure progression and death. Forty-one patien ts had renal dysfunction, hepatic disease or loss of consciousness aft er the onset of the acute heart failure, and 26 of them (63%) died of progressive heart failure during the follow-up period of 20 months on average. The one-year survival rate was 22%. Although 51 other patient s showed the same initial clinical features and cardiac function, they did not develop concurrent organ dysfunction during the course and on ly 11 (22%, p < 0.001) died of progressive heart failure. The one-year survival rate was 67%. The survival rate decreased in the order of re nal dysfunction, hepatic disease and loss of consciousness. Transient low cardiac output of less than 2.2 l/min/m(2) was more frequent in pa tients with organ dysfunction. It is suggested that heart failure prog resses, in part, due to organ dysfunction secondary to heart failure a nd careful treatment to prevent organ dysfunction is important to long term survival.