Long-term prognosis and risk factors for cardiac adverse events in patients with chronic systolic heart failure due to hypertension.

Objectives: The long-term prognosis and predictors of adverse cardiac events in hypertension-related chronic systolic heart failure (CHF) remain uncertain. Therefore, we sought to determine the major adverse cardiac events (MACE) in this group of patients.

Patients And Methods: One hundred and thirty two patients (83% males, age 48.6 +/- 8.2 years) in NYHA class II and III with hypertension-related chronic CHF were prospectively evaluated for three years. Hypertension was defined as blood pressure > or = 140/90 mmHg documented clinically twice for at least 5 years before the onset of CHF symptoms. All patients underwent coronary angiography to exclude coronary artery disease as a cause of CHF. Analysis of predictors of MACE (death, urgent heart transplantation and re-admission to the hospital due to CHF progression) during the 3 years of follow up was performed.

Results: After follow up the frequency of MACE was 41.7%. The independent predictors of MACE occurrence were as follows: the symptoms of depression [hazard ratio (HR) 2.58 (95% CI 1.44-4.63, p < 0.01)], end-diastolic diameter of the right ventricular (EDDRV) [HR 1.07 (95% CI 1.02-1.12, p < 0.01)] and D-dimers [HR 2.24 (95% CI 1.08-4.67, p < 0.05)]. To define optimal prognostic accuracy of EDDRV and D-dimers the receiver operating characteristics curve analysis was performed. The cut-off for EDDRV was 28 mm (sensitivity 50%, specificity 67.6%, area under curve [AUC] 0.64, p < 0.01) and for D-dimers 0.23 microg/ml, (sensitivity 58%, specificity 64.2%, AUC 0.62, p < 0.05).

Conclusions: In analysed group the symptoms of depression, higher baseline right ventricular diastolic diameter and higher baseline D-dimers level were independent predictors of MACE.