LONG-TERM SURVIVAL IN PATIENTS WITH MILD OR MODERATE IMPAIRMENT OF LEFT-VENTRICULAR CONTRACTILITY DURING ROUTINE DIAGNOSTIC LEFT VENTRICULOGRAPHY

Long-term survival in patients with mild to moderate impairment of lef t ventricular contractility in the absence of coronary artery disease has not been studied extensively but the prognosis is assumed to be go od. One hundred sixty-eight patients with angiographic evidence of mil d or moderate impairment of left ventricular contractility and no othe r significant cardiac disease at the time of routine diagnostic cardia c catheterization were studied to determine long-term survival and eve nt-free survival. Clinical characteristics, electrocardiograms, chest X-rays, laboratory data, and hemodynamics including end-diastolic volu me, end-systolic volume, stroke volume, ejection fraction, and regiona l wall motion at the time of catheterization were examined. Patients w ith moderate impairment were more likely to have dyspnea (P = 0.005) a nd an abnormal electrocardiogram (P = 0.006) than patients with mild i mpairment, Mean ejection fraction was 57% (P = 0.0001 vs. normal) in p atients with mild impairment and was 47% (P = 0.0001 vs, normal) in pa tients with moderate impairment. Wall motion studies showed impairment to be generalized and more significantly abnormal in patients with mo derate impairment. Survival at a mean of 138 months could be determine d in 162 of the 168 patients (96%), Fourteen year actuarial survival w as 92% for patients with mild impairment compared to 75% for patients with moderate impairment (P = 0.01). Long-term prognosis is good in pa tients found to have mild generalized impairment at the time of routin e diagnostic cardiac catheterization, In patients with moderate impair ment, closer follow-up to prevent arrhythmia and the onset of congesti ve heart failure appears to be warranted. (C) 1998 Wiley-Liss, Inc.