Predictors of short-term outcome in Chinese patients with ambulatory heartfailure for heart transplantation with ejection fraction < 25%

Heart transplantation (HT) provides longer survival than that of the natura l history in patients with dilated cardiomyopathy (DCM). However, the optim al timing for cardiac transplantation and predictors of mortality in patien ts with end-stage cardiomyopathy (ESCM) has been poorly defined. The primar y purpose of this study focused on the natural history of ambulatory patien ts with ESCM for HT assessment. Secondly, Lye tried to determine prognostic factors of individuals with the poorest short-term outcome and the optimal timing for HT in patients with ESCM. Finally, clinical treatment with angi otensin converting-enzyme inhibitors (ACEIs), carvedilol and amiodarone in the prevention of mortality caused by ESCM, were retrospectively evaluated. The short-term outcomes of 119 referral patients with ESCM for four years w ere observed. The patients had New York Heart Association class III to IV d yspnea at initial assessment for HT. Left ventricular ejection fraction (LV EF) was 17 +/- 6 % and cardiac index (CI) was 2.0 +/- 0.6 l / min / m(2). A fter optimization of medical treatment, the patients were divided into two major groups according to CI equal to or less than 2.0 l / min / m(2) and m ore than 2.0 l / min / m(2). HTs were accepted in 58 patients and the patie nts were divided into two groups: medical treatment (group 1, 56 patients) or HT (group 3, 32 patients); HT was not accepted in the other 31 patients (group 2). We studied the probability of the survival curve and prognostic variables of the groups with medical treatment in the follow-up of 12 +/- 9 months. During follow-up, 49 patients were alive without HT. The remaining 38 patie nts died; 27 patients were in group 1 and 11 patients were in group 2. Eigh t deaths in group 2 were sudden. The actuarial survival rate among the non- MT population was 73 %, 68 %, 63 %, and 56 % at 3, 6, 9 and 12 months, resp ectively. The actuarial survival rate among group 1 was 70 %, 59 %, 55 %, a nd 52 % at 3, 6, 9 and 12 months, respectively. The actuarial survival rate among group 2 was 87 %, 85 %, 77 %, and 65 % at 3, 6, 9 and 12 months, res pectively. A comparison, excluding patients with HT, was performed with tho se who had survived < 1 year and greater than or equal to 1 year after asse ssment, and those who had died. Two parameters were independent predictors of prognosis on univariate and multivariate analysis: total pulmonary vascu lar resistance (TPR) greater than or equal to 14 Wood units (W) and CI < 1. 65 l / t min m(2) at 6 and 12 months after assessment. Treatment with amiod arone for ventricular tachycardia (VT) showed no convincing role in the pre vention of sudden death in our patients. Also, treatment with ACEIs or carv edilol for heart failure was unconvincing to improve the short-term outcome in this study. Our results suggest in properly selected patients that HT should be conside red within six months among patients with severe heart failure. Hemodynamic parameters associated with right cardiac function are important determinan ts of mortality caused by progressive heart failure. Predictors such as CI and TPR may be considered as important markers of mortality in prediction o f short-term outcome in patients with ESCM, as other predictors reported in the literature.