Serial Versus Isolated Assessment of Clinical and Instrumental
Serial Versus Isolated Assessment of Clinical and Instrumental
Background: In heart failure (HF), it is not known whether analysis of serial changes in prognostic parameters provides incremental information with respect to comprehensive isolated clinical and instrumental assessments.
Methods: We analyzed time-related changes in a period ≥ 6 months in a broad panel of clinical and instrumental (electrocardiographic, echocardiographic, hemodynamic, and cardiopulmonary) parameters in 105 patients with HF (age, 53 ± 10 years; 88% men; 55% New York Heart Association classification III-IV; EF, 24% ± 6%).
Results: Among the time-related parameters, QRS widening (adjusted RR per 10 ms, 1.21; 95% CI, 1.10-1.48; P = .003) and peak oxygen uptake (pVO2) decrease (adjusted RR per mL/Kg/min, 1.11; 95% CI, 1.01-1.22; P = .034) provided independent, incremental information for predicting cardiac death/need for heart transplantation (CD/HT) with respect to the entire panel of isolated readings. The overall rate of CD/HT-free survival after 12 months was 60% ± 5%. Patients who were clinically stable with QRS widening and pVO2 decrease values of < 10% had a better CD/HT event-free survival rate at 1 year (92% ± 5% vs 50% ± 6%; P < .001).
Conclusions: This study indicates that analysis of time-related changes in prognostic parameters provides relevant incremental prognostic information and may help in the risk stratification of patients with HF and the selection of candidates for HT. In particular, patients who were clinically stable and had QRS widening and a pVO2 decreases < 10% in a period ≥ 6 months appear to be characterized by a good prognosis and may not be suitable candidates for HT.
Reliable risk stratification in heart failure (HF) is imperative. However, many attempts to identify high-risk subgroups of HF patients have given unsatisfactory results. The problem is partially caused by the way prognostic parameters vary during the course of the disease; thus, measurement at a single time cannot fully delineate disease severity. Despite deserving special attention because of their relevance, the few available studies on the prognostic implications of serial changes in prognostic indicators have often provided conflicting results. Moreover, none of the existing studies comprehensively evaluated whether serial changes in a broad panel of commonly used prognostic parameters can provide additional information on isolated readings. A study of this sort may be particularly valuable because physicians tend to make some sort of global serial analysis in their routine practice anyway in an attempt to maximize diagnostic accuracy. It was previously shown that accelerated QRS widening provides independent additional prognostic information with respect to comprehensive clinical and instrumental assessment at a given time point. In this study, we investigated the prognostic significance of temporal changes in a broad panel of clinical, electrocardiographic, echocardiographic, hemodynamic, and cardiopulmonary parameters.
Background: In heart failure (HF), it is not known whether analysis of serial changes in prognostic parameters provides incremental information with respect to comprehensive isolated clinical and instrumental assessments.
Methods: We analyzed time-related changes in a period ≥ 6 months in a broad panel of clinical and instrumental (electrocardiographic, echocardiographic, hemodynamic, and cardiopulmonary) parameters in 105 patients with HF (age, 53 ± 10 years; 88% men; 55% New York Heart Association classification III-IV; EF, 24% ± 6%).
Results: Among the time-related parameters, QRS widening (adjusted RR per 10 ms, 1.21; 95% CI, 1.10-1.48; P = .003) and peak oxygen uptake (pVO2) decrease (adjusted RR per mL/Kg/min, 1.11; 95% CI, 1.01-1.22; P = .034) provided independent, incremental information for predicting cardiac death/need for heart transplantation (CD/HT) with respect to the entire panel of isolated readings. The overall rate of CD/HT-free survival after 12 months was 60% ± 5%. Patients who were clinically stable with QRS widening and pVO2 decrease values of < 10% had a better CD/HT event-free survival rate at 1 year (92% ± 5% vs 50% ± 6%; P < .001).
Conclusions: This study indicates that analysis of time-related changes in prognostic parameters provides relevant incremental prognostic information and may help in the risk stratification of patients with HF and the selection of candidates for HT. In particular, patients who were clinically stable and had QRS widening and a pVO2 decreases < 10% in a period ≥ 6 months appear to be characterized by a good prognosis and may not be suitable candidates for HT.
Reliable risk stratification in heart failure (HF) is imperative. However, many attempts to identify high-risk subgroups of HF patients have given unsatisfactory results. The problem is partially caused by the way prognostic parameters vary during the course of the disease; thus, measurement at a single time cannot fully delineate disease severity. Despite deserving special attention because of their relevance, the few available studies on the prognostic implications of serial changes in prognostic indicators have often provided conflicting results. Moreover, none of the existing studies comprehensively evaluated whether serial changes in a broad panel of commonly used prognostic parameters can provide additional information on isolated readings. A study of this sort may be particularly valuable because physicians tend to make some sort of global serial analysis in their routine practice anyway in an attempt to maximize diagnostic accuracy. It was previously shown that accelerated QRS widening provides independent additional prognostic information with respect to comprehensive clinical and instrumental assessment at a given time point. In this study, we investigated the prognostic significance of temporal changes in a broad panel of clinical, electrocardiographic, echocardiographic, hemodynamic, and cardiopulmonary parameters.
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