Prognosis in patients with severe heart failure referred for heart transplantation--POLKARD-HF 2003-2007.

POLKARD-HF study was a prospective registry of patients, referred for the heart transplantation. The registry collected data on factors influencing the prognosis of patients. The death or the emergency heart transplantation (UNOS status 1) was assumed as the endpoint in the distant observation. 983 patients (88% men, mean age <50) with severe heart failure (HF), referred to 4 centers were analyzed. The average period of observation was 601 days (1 to 1462 days). The Kaplan-Meier probability of surviving 1 year without urgent heart transplantation was 80%, 2 years 70%, and 3 years 67%. HF etiology was dilated cardiomyopathy in 49.4% and ischemic cardiomyopathy in 43.2%. There was only a trend in favor of survival of patients with dilated cardiomyopathy (p=0.1). Prognosis in patients with NYHA classes II and III did not differ but in NYHA IV, was significantly worse. The probability of 6-month survival was 60%, 1-year--50%, and 3-year--40%. In Kaplan-Meier analysis survival was worse for pts with pulmonary artery systolic pressure ≥50 mmHg, pulmonary capillary pressure ≥25 mmHg, left ventricular ejection fraction ≤17%, functional NYHA class IV, systemic systolic arterial pressure ≤90 mmHg, hsCRP≥6.5 mg/L, NTpro-BNP≥4302, Na serum level≤135 mEq/L, BMI≤23.8, and HFSS≤7.19. When only biochemistry parameters were analyzed using ROC, sodium plasma levels ≤135 mEq/L alone gave ROC 58.3% and inclusion of NTpro-BNP≥4302 pg/mL into the model, increased the predictive value up to 61.2%.