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. 2011;66(2):239-44.
doi: 10.1590/s1807-59322011000200010.

Predictors of low cardiac output in decompensated severe heart failure

Marcelo Eidi Ochiai  1 , Juliano Novaes Cardoso, Kelly Regina Novaes Vieira, Marcelo Villaça Lima, Euler Cristovan Ochiai Brancalhao, Antonio Carlos Pereira Barretto
Affiliations

Predictors of low cardiac output in decompensated severe heart failure

Marcelo Eidi Ochiai et al. Clinics (Sao Paulo). 2011.

Abstract

Objective: To identify predictors of low cardiac output and mortality in decompensated heart failure.

Introduction: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, and its management is controversial.

Methods: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of <0.45. Patients underwent clinical-hemodynamic assessment and Chagas disease immunoenzymatic assay. Low cardiac output was defined according to L and C clinical-hemodynamic profiles. Multivariate analyses assessed clinical outcomes. P<0.05 was considered significant.

Results: The mean age was 60.1 years; 245 (54.2%) patients were >60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P<0.001), lower ejection fraction (RR: 2.414, P<0.001), hyponatremia (RR: 1.618, P = 0.036), and renal dysfunction (RR: 1.916, P = 0.007). Elderly patients were inversely associated with low cardiac output (RR: 0.436, P = 0.001). Predictors of mortality were Chagas disease (RR: 2.286, P<0.001), ischemic etiology (RR: 1.449, P = 0.035), and low cardiac output (RR: 1.419, P = 0.047).

Conclusions: In severe decompensated heart failure, predictors of low cardiac output are Chagas disease, lower ejection fraction, hyponatremia, and renal dysfunction. Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.

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Figures

Figure 1
Figure 1
Predictors of low cardiac output in decompesated heart failure.
Figure 2
Figure 2
Predictors of all‐cause mortality.
Figure 3
Figure 3
Survival curves according to Chagas disease or not.
Figure 4
Figure 4
Survival curves according to renal function evolution. CrCl  =  creatinine clearance.
See this image and copyright information in PMC

Comment in

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