Predictors of total mortality and sudden death in mild to moderate heart failure. Captopril-Digoxin Study Group

Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510.

The relation between baseline clinical variables and subsequent mortality was examined in 295 patients with mild to moderate heart failure who participated in a multicenter trial comparing the effect on treadmill exercise tolerance of captopril, digoxin and placebo given in addition to a diuretic drug. At baseline study, all patients had a left ventricular ejection fraction less than or equal to 40%; 81% were in New York Heart Association functional class II. The etiology of heart failure was ischemic in 62% and nonischemic in 38%. During an average follow-up period of 16 months, 47 patients (16%) died and 24 deaths were classified as sudden. By univariate analysis, left ventricular ejection fraction, ventricular premature beat frequency, couplet frequency, ventricular tachycardia frequency, functional class, treadmill exercise time and nonischemic heart disease were statistically associated with mortality. With multiple logistic regression analysis, left ventricular ejection fraction was identified as the variable most closely associated with total mortality (p = 0.006). Twenty-seven percent of patients with an ejection fraction less than or equal to 20% died compared with 7% with an ejection fraction greater than or equal to 30%. Ventricular tachycardia frequency on Holter monitoring was independently associated with both total mortality (p = 0.008) and sudden death (p = 0.003). Patients with a ventricular tachycardia frequency of greater than 0.088 events/h had a mortality rate of 34% compared with 12% in those without ventricular tachycardia. In the multivariate model, functional class (p = 0.02) and etiology of nonischemic heart disease (p = 0.04) remained as independent predictors of mortality, whereas treadmill exercise duration did not.(ABSTRACT TRUNCATED AT 250 WORDS)

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				R. D. Berger, E. K. Kasper, K. L. Baughman, E. Marban, H. Calkins, and G. F. Tomaselli Beat-to-Beat QT Interval Variability : Novel Evidence for Repolarization Lability in Ischemic and Nonischemic Dilated Cardiomyopathy Circulation, September 2, 1997; 96(5): 1557 - 1565. [Abstract] [Full Text]

				K. D. Aaronson, J. S. Schwartz, T.-M. Chen, K.-L. Wong, J. E. Goin, and D. M. Mancini Development and Prospective Validation of a Clinical Index to Predict Survival in Ambulatory Patients Referred for Cardiac Transplant Evaluation Circulation, June 17, 1997; 95(12): 2660 - 2667. [Abstract] [Full Text]

				S. Saksena and I. Giorgberidze The Multicenter Automatic Defibrillator Implantation Trial: MADIT Provides the Basis for Developing Therapeutic Strategy for Patients With Severely Depressed Ventricular Ejection Fraction With Nonsustained Ventricular Tachycardia Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1997; 2(3): 229 - 234. [PDF]

				D. B. Chomsky, C. C. Lang, G. H. Rayos, Y. Shyr, T.-K. Yeoh, R. N. Pierson III, S. F. Davis, and J. R. Wilson Hemodynamic Exercise Testing: A Valuable Tool in the Selection of Cardiac Transplantation Candidates Circulation, December 15, 1996; 94(12): 3176 - 3183. [Abstract] [Full Text]

				H. C. Doval, D. R. Nul, H. O. Grancelli, S. D. Varini, S. Soifer, G. Corrado, S. Dubner, O. Scapin, and S. V. Perrone Nonsustained Ventricular Tachycardia in Severe Heart Failure: Independent Marker of Increased Mortality due to Sudden Death Circulation, December 15, 1996; 94(12): 3198 - 3203. [Abstract] [Full Text]

				M. R. Costanzo, S. Augustine, R. Bourge, M. Bristow, J. B. O'Connell, D. Driscoll, and E. Rose Selection and Treatment of Candidates for Heart Transplantation : A Statement for Health Professionals From the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association Circulation, December 15, 1995; 92(12): 3593 - 3612. [Abstract] [Full Text]

				M. O. Sweeney, J. N. Ruskin, H. Garan, B. A. McGovern, M. L. Guy, D. F. Torchiana, G. J. Vlahakes, J. B. Newell, M. J. Semigran, and G. W. Dec Influence of the Implantable Cardioverter/Defibrillator on Sudden Death and Total Mortality in Patients Evaluated for Cardiac Transplantation Circulation, December 1, 1995; 92(11): 3273 - 3281. [Abstract] [Full Text]

				G. W. Dec and V. Fuster Idiopathic Dilated Cardiomyopathy N. Engl. J. Med., December 8, 1994; 331(23): 1564 - 1575. [Full Text]

				R. J. Cody, S. H. Kubo, and K. K. Pickworth Diuretic Treatment for the Sodium Retention of Congestive Heart Failure Arch Intern Med, September 12, 1994; 154(17): 1905 - 1914. [Abstract] [PDF]

				V. Bittner, D. H. Weiner, S. Yusuf, W. J. Rogers, K. M. McIntyre, S. I. Bangdiwala, M. W. Kronenberg, J. B. Kostis, R. M. Kohn, M. Guillotte, et al. Prediction of Mortality and Morbidity With a 6-Minute Walk Test in Patients With Left Ventricular Dysfunction JAMA, October 13, 1993; 270(14): 1702 - 1707. [Abstract] [PDF]

				S. V. Abramson, J. F. Burke, J. J. Kelly Jr., J. G. Kitchen III, M. J. Dougherty, D. F. Yih, F. C. McGeehin III, J. W. Shuck, and T. P. Phiambolis Pulmonary Hypertension Predicts Mortality and Morbidity in Patients with Dilated Cardiomyopathy Ann Intern Med, June 1, 1992; 116(11): 888 - 895. [Abstract] [PDF]

				A. M. Feldman Can We Alter Survival in Patients With Congestive Heart Failure? JAMA, April 8, 1992; 267(14): 1956 - 1961. [Abstract] [PDF]