Three year mortality in heart failure patients with very low left ventricular ejection fractions

Background: Left ventricular ejection fraction is a predictor of the outcom e in patients with chronic heart failure. Some treatments cause a small inc rease in ejection fraction and may, thereby, improve prognosis. Method: We studied 99 patients with heart failure and very low left ventricular ejecti on fractions (all less than or equal to 20%). Seventy-four patients had eje ction fractions of 11-20% and 25 had less than or equal to 10%. Patient fol low up was censored at three years. Results: Mortality was 74% at three yea rs. Left ventricular ejection fraction was not a predictor of mortality (P= 0.36). In contrast, peak VO2 at the beginning of the study was a strong pre dictor of outcome (P=0.002). Conclusion: Three year survival is low when ej ection fraction is very low. However, once the ejection fraction is less th an or equal to 20% ejection fraction is no longer a predictor of mortality. These results suggest that it is unlikely that small increases in ejection fraction will be associated with a survival benefit in this group, and tre atments aimed at increasing peak VO2 may be more appropriate. (C) 1999 Else vier Science Ireland Ltd. All rights reserved.