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Exercise Capacity Is the Most Powerful Predictor of 2-Year Mortality in Patients with Left Ventricular Systolic Dysfunction

Einfluss der körperlichen Leistungsfähigkeit auf die 2-Jahres-Mortalität von Patienten mit systolischer Linksherzinsuffizienz

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Abstract

Background:

There are few data about predictors of cardiovascular mortality and rehospitalization rate in patients with left ventricular systolic dysfunction (LVSD) after myocardial revascularization and optimization of pharmacological treatment.

Patients and Methods:

1,346 consecutive patients with left ventricular ejection fraction (LVEF) < 45% (64 ± 10 years, 73% male, LVEF 36.3% ± 8%), who were referred for inpatient cardiac rehabilitation, were followed prospectively for 731 ± 215 days in a unicentric prospective longitudinal registry. Multivariate logistic regression Cox models were used to analyze demographic, echocardiographic and exercise variables in order to determine independent predictors of cardiovascular mortality and rehospitalization.

Results:

LVEF failed to show prognostic power (hazard ratio [HR] 0.99 [95% confidence interval, CI, 0.94–1.03]; p = not significant), whereas moderate to severe mitral regurgitation (HR, 5.71 [95% CI 1.75–18.6]; p = 0.004) and atrial fibrillation (HR 1.67 [95% CI 1.15–2.44]; p = 0.008) were associated with a poorer prognosis. In an optimized multivariate model, 6-min walk test (HR 0.93 [95% CI 0.86–1.00] per 50 m; p = 0.049) and symptom-limited maximum exercise capacity test (HR 0.83 [95% CI 0.76–0.91] per 10 W; p < 0.001) as well as female gender (HR 0.58 [95% CI 0.39–0.84]; p = 0.005) were strong predictors for reduced overall mortality.

Conclusion:

In patients with LVSD, independently of LVEF, traditional prognostic factors including atrial fibrillation or mitral regurgitation predict poorer survival, whereas symptom-limited exercise capacity and walking distance performed in 6-min walk test were highly predictive for a good prognosis.

Zusammenfassung

Hintergrund:

Bei revaskularisierten und medikamentös leitlinienorientiert therapierten Patienten mit linksventrikulärer systolischer Dysfunktion sind prognostische Parameter für kardiovaskuläre Mortalität und Rehospitalisierung unzureichend bekannt.

Patienten und Methodik:

1 346 konsekutive Patienten mit einer linksventrikulären Ejektionsfraktion (LVEF) < 45% (64 ± 10 Jahre, 73% männlich, LVEF 36,3% ± 8%) wurden im Rahmen einer kardiologischen Rehabilitation in einem unizentrischen prospektiven Register erfasst und 731 ± 215 Tage nachbeobachtet. In einer multivariaten Cox-Regressionsanalyse wurde der Einfluss demographischer, echokardiographischer und funktioneller Parameter auf die Endpunkte kardiovaskuläre Mortalität und Rehospitalisationsrate beurteilt.

Ergebnisse:

Die LVEF zeigte keinen signifikanten prognostischen Einfluss (Hazard-Ratio [HR] 0,99 [95%-Konfidenzintervall, CI, 0,94–1,03]; p = nicht signifikant), wohingegen das Vorliegen einer höhergradigen Mitralklappeninsuffizienz (HR 5,71 [95%-CI 1,75–18,6]; p = 0,004) und eines Vorhofflimmerns (HR 1,67 [95%-CI 1,15–2,44]; p = 0,008) mit einer schlechten Prognose assoziiert war. Im optimierten Gesamtmodell wiesen eine bessere körperliche Leistungsfähigkeit im 6-min-Gehtest (HR 0,93 [95%-CI 0,86–1,00] pro 50 m; p = 0,049) und in der symptomlimitierten Ergometrie (HR 0,83 [95%-CI 0,76–0,91] pro 10 W; p < 0,001) sowie weibliches Geschlecht (HR 0,58 [95% CI 0,39–0,84]; p = 0,005) die höchste Vorhersagekraft für eine reduzierte Gesamtmortalität auf.

Schlussfolgerung:

Traditionelle prognostische Risikofaktoren wie Vorhofflimmern oder eine höhergradige Mitralklappeninsuffizienz sind bei Patienten mit systolischer Linksherzinsuffizienz unabhängig von der linksventrikulären Ejektionsfraktion mit einer Steigerung der Mortalitätsrate assoziiert. Demgegenüber sind die maximale Leistungsfähigkeit in der Ergometrie und im 6-min-Gehtest positive Prädiktoren für die Langzeitprognose.

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Authors and Affiliations

  1. Department of Cardiology, Rehabilitation Center of Cardiovascular Disease, Klinik am See, Rüdersdorf/Berlin, Germany

    Rona K. Reibis MD, Bettina Ehrlich & Heinz Völler

  2. Kardiologische Gemeinschaftspraxis, Am Park, Sanssouci Potsdam, Potsdam, Germany

    Rona K. Reibis MD

  3. Department of Medical, Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany

    Andras Treszl & Karl Wegscheider

  4. Zentralkrankenhaus Reinkenheide, Bremerhaven, Germany

    Rüdiger Dissmann

  5. Kardiologische Gemeinschaftspraxis, Am Park, Sanssouci Potsdam, Zimmerstraße 7, 14471, Potsdam, Germany

    Rona K. Reibis MD

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  1. Rona K. Reibis MD
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Correspondence to Rona K. Reibis MD.

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Reibis, R.K., Treszl, A., Wegscheider, K. et al. Exercise Capacity Is the Most Powerful Predictor of 2-Year Mortality in Patients with Left Ventricular Systolic Dysfunction. Herz 35, 104–110 (2010). https://doi.org/10.1007/s00059-010-3226-5

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  • DOI: https://doi.org/10.1007/s00059-010-3226-5

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