PROGNOSTIC-SIGNIFICANCE OF SERIAL CHANGES IN LEFT-VENTRICULAR EJECTION FRACTION IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

Background. In congestive heart failure patients, a single measurement of left ventricular ejection fraction (LVEF) provides important progn ostic information. The importance, if any, of improvement or worsening in serial LVEF has not been defined. The Department of Veterans Affai rs Cooperative Vasodilator-Heart Failure Trials (V-HeFT) data base was analyzed to determine the prognostic importance of LVEF changes. Meth ods and Results. The data bases for V-HeFT I (n=642) and V-HeFT II (n= 804) were analyzed. All patients had heart failure with documented exe rcise intolerance and abnormal LVEF or cardiac dilatation by chest x-r ay or echocardiography. Radionuclide LVEF was obtained at baseline, wi thin 6 months, and at least yearly after randomization to treatment. C umulative survival subsequent to LVEF follow-up measurements was calcu lated for strata defined by LVEF change from baseline. In V-HeFT I, pa tients treated with hydralazine/isosorbide dinitrate (H-1) experienced a significant (p<0.001) increase in LVEF and a survival advantage ove r those treated with placebo and prazosin. In V-HeFT II, both treatmen t groups showed significant improvements in LVEF, with the increase wi th H-I greater than that with enalapril, and enalapril provided a sign ificant survival advantage over H-1. Change (>5) in LVEF from baseline at 6 months (V-HeFT I) and 1 year (V-HeFT II) were the strongest pred ictors of mortality among the serial measurements and were significant after adjustment for therapy and baseline LVEF. Baseline clinical var iables were not helpful in predicting the patients who would experienc e an improvement in LVEF. Conclusions. In patients with heart failure, serial measurements of LVEF provide additional important prognostic i nformation. Vasodilator therapy with H-1 is associated with an improve ment in LVEF and prognosis. Vasodilator therapy with enalapril improve s LVEF less than H-1 but provides an additional survival benefit.