Información del artículo
La insuficiencia cardíaca es un problema de salud pública cada vez más relevante y uno de los mayores retos sanitarios para el nuevo siglo. Constituye una entidad patológica fundamental en el conjunto de las enfermedades cardiovascuclares, que engloba componentes hemodinámicos, neuroendocrinos y congestivos.
De entre las características clinicodemográficas, las determinaciones bioquímicas y neurohumorales y las distintas pruebas complementarias (electrocardiograma, radiografía de tórax, ecocardiograma, cardiología nuclear, prueba de esfuerzo y hemodinámica) utilizadas en el diagnóstico y valoración de la insuficiencia cardíaca, los indicadores que se han revelado más fiables como predictores del pronóstico han sido: la fracción de eyección del ventrículo izquierdo, la liberación cardíaca y concentración plasmática de noradrenalina, el péptido natriurético cerebral (BNP), el consumo de oxígeno máximo (VO2max), la edad y la presencia de arritmias ventriculares sintomáticas.
Palabras clave:
insuficiencia cardíaca
factores pronósticos
Cardiac failure is an increasingly more relevant health care problem and one of the greatest health care challenges for the new century. It constitutes a fundamental disease entity in the combination of cardiovascular diseases, which include hemodynamic, neuroendocrine and congestive components.
Among the clinical-demographic characteristics, the biochemical and neurohumoral measurements and the different complementary tests (electrocardiogram, chest X-ray, echocardiogram, nuclear cardiology, stress test and hemodynamic test) used in the diagnosis and assessment of cardiac failure, the indicators that have been revealed as the most reliable as predictors of the prognosis, have been: left ventricle ejection fraction, cardiac release and norepinephrine plasma concentration, BNP, VO2max, age and presence of symptomatic ventricular arrithymias.
Key words:
cardiac failure
prognostic factors
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Bibliografía
[1.]
The Task Force on Heart Failure of the European Society of Cardiology.
Guidelines for the diagnosis of heart failure.
Eur Heart J, 16 (1995), pp. 741-751
[2.]
M.R. Cowie, A. Mostrd, D.A. Wood, J.W. Deckers, P.A. Poole-Wilson, G.C. Sutton, et al.
The epidemiology of heart failure.
Eur Heart J, 18 (1997), pp. 208-225
[3.]
K.L. Kalon, L. Ho, J.L. Pinsky, B. William, W.B. Kannel, D. Levy.
The epidemiology of heart failure. The Framingham Study.
J Am Coll Cardiol, 22 (1993), pp. 6A-13A
[4.]
D.D. Schocken, M.I. Arrieta, P.E. Leaverton, E.A. Ross.
Prevalence and mortality rate of congestive heart failure in the United States.
J Am Coll Cardiol, 20 (1992), pp. 301-306
[5.]
F.A. Kirkwood.
New epidemiologic perspectives cocerning mild to moderate heart failure.
Am J Med, 110 (2001), pp. 6S-13S
[6.]
K.L. Ho, K.M. Anderson, W.B. Kannel, W. Grossman, D. Levy.
Survival after the onset of congestive heart failure in Framingham heart study subjects.
Circulation, 88 (1993), pp. 107-115
[7.]
J.r. Adams KF, S.H. Dunlap, C.A. Sueta, S.W. Clarke, J.H. Patterson, M.B. Blauwet, et al.
Relation between gender, etiology and survival in patients with symptomatic heart failure.
J Am Coll Cardiol, 28 (1996), pp. 1781-1788
[8.]
B.A. Bart, L.K. Shaw, C.B. McCants Jr, D.F. Fortin, K.L. Lee, R.M. Califf, et al.
Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy.
J Am Coll Cardiol, 30 (1997), pp. 1002-1008
[9.]
P.J. Cowburn, J.G.F. Cleland, A.J.S. Coats, M. Komajda.
Risk stratification in chronic heart failure.
Eur Heart J, 19 (1998), pp. 696-710
[10.]
M.G. Bourassa, O. Gurne, S.I. Bangdiwala, J.K. Ghali, J.B. Young, M. Rousseau.
et al for the Study of Left Ventricular Disfunction (SOLVD) Investigators. Natural history and patterns of current practice in heart failure.
J Am Coll Cardiol, 22 (1993), pp. 14A-19A
[11.]
E.J. Eichhorn.
Prognosis determination in heart failure.
Am J Med, 110 (2001), pp. 14S-35S
[12.]
R. Pernenkil, J.M. Vinson, A.S. Shah, V. Beckham, C. Wittenberg, M.W. Rich.
Course and prognosis in patients > or = 70 years of age with congestive heart failure and normal versus abnormal left ventricular ejection fraction.
Am J Cardiol, 79 (1997), pp. 216-219
[13.]
A. Gradman, P. Deedwania, R. Cody, B. Massie, M. Packer, B. Pitt, et al.
Predictors of total mortality and sudden death in mild to moderate heart failure. Captopril-Digoxin Study Group.
J Am Coll Cardiol, 14 (1989), pp. 564-570
[14.]
B.K. Madsen, N. Keller, E. Christiansen, N.J. Christiansen.
Prognostic value of plasma catecholomines, plasma renin activity, and plasma atrial natriuretic peptide at rest and during exercise in congestive heart failure: comparison with clinical evaluation, ejection fraction, and exercise capacity.
Cardiac Failure, 1 (1995), pp. 207-216
[15.]
M. Komajda, J.P. Jais, F. Reeves, B. Goldfarb, J.B. Bouhour, Y. Juillieres, et al.
Factors predicting mortality in idiopathic dilated cardiomyopathy.
Eur Heart J, 11 (1990), pp. 824-831
[16.]
H.R. Middlekauff, W.G. Stevenson, L.W. Stevenson, L.A. Saxon.
Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope.
J Am Coll Cardiol, 21 (1993), pp. 110-116
[17.]
The SOLVD Investigators.
Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.
N Engl J Med, 325 (1991), pp. 293-302
[18.]
D.M. Shindler, J.B. Kostis, S. Yusuf, M.A. Quinones, B. Pitt, D. Stewart, et al.
Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry.
Am J Cardiol, 77 (1996), pp. 1017-1020
[19.]
K.D. Aaronson, J.S. Schwartz, T.M. Chen, K.L. Wong, J.E. Goin, D.M. Mancini.
Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation.
Circulation, 95 (1997), pp. 2660-2667
[20.]
J.G. Cleland, H.J. Dargie, I. Ford.
Mortality in heart failure: clinical variables of prognostic value.
Br Heart J, 58 (1987), pp. 572-582
[21.]
J. Parameshwar, J. Keegan, J. Sparrow, G.C. Sutton, P.A. Poole-Wilson.
Predictors of prognosis in severe chronic heart failure.
Am Heart J, 123 (1992), pp. 421-426
[22.]
H.J. Dargie, J.G. Cleland, B.J. Leckie, C.G. Inglis, B.W. East, I. Ford.
Relation of arrhythmias and electrolyte abnormalities to survival in patients with severe chronic heart failure.
Circulation, 75 (1987), pp. IV98-IV107
[23.]
S.S. Gottlieb, L. Baruch, M.L. Kukin, J.L. Bernstein, M.L. Fisher, M. Packer.
Prognostic importance of the serum magnesium concentration in patients with congestive heart failure.
J Am Coll Cardiol, 16 (1990), pp. 827-831
[24.]
W.H. Lee, M. Packer.
Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure.
Circulation, 73 (1986), pp. 257-267
[25.]
P. Batin, M. Wickens, D. McEntegart, L. Fullwood, A.J. Cowley.
The importance of abnormalities of liver function tests in predicting mortality in chronic heart failure.
Eur Heart J, 16 (1995), pp. 1613-1618
[26.]
J.N. Cohn, G.R. Johnson, R. Shabetai, H. Loeb, F. Tristani, T. Rector, et al.
for the V-HeFT VA Cooperative Studies Group. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure.
Circulation, 87 (1993), pp. 5-6
[27.]
G.S. Francis, J.N. Cohn, G. Johnson, T.S. Rector, S. Goldman, A. Simon.
for the V-HeFT VA Cooperative Studies Group. Plasma norepinephrine, plasma renin activity, and congestive heart failure Relations to survival and the effects of therapy in V-HeFT II.
Circulation, 87 (1993), pp. 40-48
[28.]
K. Swedberg, P. Eneroth, J. Kjekshus, L. Wilhelmsen.
for the CONSENSUS Trial Study Group. Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality.
Circulation, 82 (1990), pp. 1730-1736
[29.]
D.M. Kaye, J. Lefkovits, G.L. Jennings, P. Bergin, A. Broughton, M.D. Esler.
Adverse consequences of high sympathetic nervous activity in the failing human heart.
J Am Coll Cardiol, 26 (1995), pp. 1257-1263
[30.]
L. Fauchier, D. Babuty, P. Cosnay, J.P. Fauchier.
Prognostic value of heart rate variability for sudden death and major arrhythmic events in patients with idiopathic dilated cardiomyopathy.
J Am Coll Cardiol, 33 (1999), pp. 1203-1207
[31.]
W. Jiang, W.R. Hathaway, S. McNulty, R.L. Larsen, K.L. Hansley, Y. Zhang, et al.
Ability of heart rate variability to predict prognosis in patients with advanced congestive heart failure.
Am J Cardiol, 80 (1997), pp. 808-811
[32.]
S.S. Gottlieb, M.L. Kukin, D. Ahern, M. Packer.
Prognostic importance of atrial natriuretic peptide in patients with chronic heart failure.
J Am Coll Cardiol, 13 (1989), pp. 1534-1539
[33.]
K. Dickstein, A.I. Larsen, V. Bonarjee, M. Thoresen, T. Aarsland, C. Hall.
Plasma proatrial natriuretic factor is predictive of clinical status in patients with congestive heart failure.
Am J Cardiol, 76 (1995), pp. 679-683
[34.]
T. Omland, A. Aakvaag, V.V. Bonarjee, K. Caidahl, R.T. Lie, D.W. Nilsen, et al.
Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide.
Circulation, 93 (1996), pp. 1963-1969
[35.]
T. Tsutamoto, A. Wada, K. Maeda, T. Hisanaga, Y. Maeda, D. Fukai, et al.
Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction.
Circulation, 96 (1997), pp. 509-516
[36.]
A.M. Richards, M.G. Nicholls, T.G. Yandle, C. Frampton, E.A. Espiner, J.G. Turner, et al.
Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction.
Circulation, 97 (1998), pp. 1921-1929
[37.]
G. Torre-Amione, S. Kapadia, C. Benedict, H. Oral, J.B. Young, D.L. Mann.
Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the Studies of Left Ventricular Dysfunction (SOLVD).
J Am Coll Cardiol, 27 (1996), pp. 1201-1206
[38.]
R. Ferrari, T. Bachetti, R. Confortini, C. Opasich, O. Febo, A. Corti, et al.
Tumor necrosis factor soluble receptors in patients with various degrees of congestive heart failure.
Circulation, 92 (1995), pp. 1479-1486
[39.]
T. Tsutamoto, T. Hisanaga, A. Wada, K. Maeda, M. Ohnishi, D. Fukai, et al.
Interleukin-6 spillover in the peripheral circulation increases with the severity of heart failure, and the high plasma level of interleukin-6 is an important prognostic predictor in patients with congestive heart failure.
J Am Coll Cardiol, 31 (1998), pp. 391-398
[40.]
T. Kubota, C.F. McTiernan, C.S. Frye, S.E. Slawson, B.H. Lemster, A.P. Koretsky, et al.
Dilated cardiomyopathy in transgenic mice with cardiac-specific overexpression of tumor necrosis factor-alpha.
Circ Res, 81 (1997), pp. 627-635
[41.]
R.J. Cody, G.J. Haas, P.F. Binkley, Q. Capers, R. Kelley.
Plasma endothelin correlates with the extent of pulmonary hypertension in patients with chronic congestive heart failure.
Circulation, 85 (1992), pp. 504-509
[42.]
R.J. Rodeheffer, A. Lerman, D.M. Heublein, J.C. Burnett Jr..
Increased plasma concentrations of endothelin in congestive heart failure in humans.
Mayo Clin Proc, 67 (1992), pp. 719-724
[43.]
F. Pousset, R. Isnard, P. Lechat, H. Kalotka, A. Carayon, G. Maistre, et al.
Prognostic value of plasma endothelin-1 in patients with chronic heart failure.
Eur Heart J, 18 (1997), pp. 254-258
[44.]
R. Pacher, B. Stanek, M. Hulsmann, J. Koller-Strametz, R. Berger, M. Schuller, et al.
Prognostic impact of big endothelin-1 plasma concentrations compared with invasive haemodynamic evaluation in severe heart failure.
J Am Coll Cardiol, 27 (1996), pp. 633-641
[45.]
H.R. Middlekauff, W.G. Stevenson, L.W. Stevenson.
Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients.
Circulation, 84 (1991), pp. 40-48
[46.]
W.G. Stevenson, L.W. Stevenson, H.R. Middlekauff, G.C. Fonarow, M.A. Hamilton, M.A. Woo, et al.
Improving survival for patients with atrial fibrillation and heart failure.
J Am Coll Cardiol, 28 (1996), pp. 1458-1463
[47.]
H.B. Xiao, C. Roy, S. Fujimoto, D.G. Gibson.
Natural history of abnormal condution and its relation to prognosis in patients with dilated cardiomyopathy.
Int J Cardiol, 53 (1996), pp. 163-170
[48.]
R. Narang, J.G.F. Cleland, L. Erhardt, S.G. Ball, A.J. Coats, A.J. Cowley, et al.
Mode of death in chronic heart failure: a request and proposition for more accurate classification.
Eur Heart J, 17 (1996), pp. 1390-1403
[49.]
D.S. Echt, P.R. Liebson, L.B. Mitchell, R.W. Peters, D. Obias-Manno, A.H. Barker.
et al for the CAST Investigators. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial.
N Engl J Med, 324 (1991), pp. 781-788
[50.]
CIBIS Investigators and Committees.
A randomized trial of betablockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS).
Circulation, 90 (1994), pp. 1765-1773
[51.]
D.B. Reese, M.E. Silverman, M.R. Gold, S.S. Gottlieb.
Prognostic importance of the length of ventricular tachycardia in patients with nonischemic congestive heart failure.
Am Heart J, 130 (1995), pp. 489-493
[52.]
R. De Maria, A. Gavazzi, A. Caroli, R. Ometto, A. Biagini, F. Camerini.
Ventricular arrhythmias in dilated cardiomyopathy as an independent prognostic hallmark. Italian Multicenter Cardiomyopathy Study (SPIC) Group.
Am J Cardiol, 69 (1992), pp. 1451-1457
[53.]
J.R. Wilson, J.S. Schwartz, M.S. Sutton, N. Ferraro, L.N. Horowitz, N. Reichek, et al.
Prognosis in severe heart failure: relation to hemodynamic measurements and ventricular ectopic activity.
J Am Coll Cardiol, 2 (1983), pp. 403-410
[54.]
K.V. Olshausen, U. Stienen, F. Schwarz, W. Kubler, J. Meyer.
Long-term prognostic significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy.
Am J Cardiol, 61 (1988), pp. 146-151
[55.]
K.K. Ho, G.B. Moody, C.K. Peng, J.E. Mietus, M.G. Larson, D. Levy, et al.
Predicting survival in heart failure case and control subjects by useof fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics.
Circulation, 96 (1997), pp. 842-848
[56.]
J. Brouwer, D.J. van Veldhuisen, A.J. Man in't Veld, J. Haaksma, W.A. Dijk, K.R. Visser, et al.
Prognostic value of heart rate variability during long-term follow-up in patients with mild to moderate heart failure. The Dutch Ibopamine Multicenter Trial Study Group.
J Am Coll Cardiol, 28 (1996), pp. 1183-1189
[57.]
B.M. Szabo, D.J. van Veldhuisen, N. van der Veer, J. Brouwer, P.A. De Graeff, H.J. Crijns.
Prognostic value of heart rate variability in chronic congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy.
Am J Cardiol, 79 (1997), pp. 978-980
[58.]
A. Mortara, M.T. La Rovere, G.D. Pinna, A. Prpa, R. Maestri, O. Febo, et al.
Arterial baroreflex modulation of heart rate in chronic heart failure: clinical and hemodynamic correlates and prognostic implications.
Circulation, 96 (1997), pp. 3450-3458
[59.]
A. Mortara, P. Sleight, G.D. Pinna, R. Maestri, A. Prpa, M.T. La Rovere, et al.
Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability.
Circulation, 96 (1997), pp. 246-252
[60.]
G. Turitto, R.K. Ahuja, E.B. Caref, N. el-Sherif.
Risk stratification for arrhythmic events in patients with nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia: role of programmed ventricular stimulation and the signal-averaged electrocardiogram.
J Am Coll Cardiol, 24 (1994), pp. 1523-1528
[61.]
B.K. Madsen, J.F. Hansen, K.H. Stokholm, J. Brons, D. Husum, L.S. Mortensen.
Chronic congestive heart failure. Description and survival of 190 consecutive patients with a diagnosis of chronic congestive heart failure based on clinical signs and symptoms.
Eur Heart J, 15 (1994), pp. 303-310
[62.]
T.L. Kelly, R. Cremo, C. Nielsen, R. Shabetai.
Prediction of outcome in late-stage cardiomyopathy.
Am Heart J, 119 (1990), pp. 1111-1121
[63.]
J.N. Cohn, T.S. Rector.
Prognosis of congestive heart failure and predictors of mortality.
Am J Cardiol, 62 (1988), pp. 25A-30A
[64.]
A. Gavazzi, C. Berzuini, C. Campana, C. Inserra, M. Ponzetta, R. Sebastiani, et al.
Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure.
J Heart Lung Transplant, 16 (1997), pp. 774-785
[65.]
D.R. Glover, W.A. Littler.
Factors influencing survival and mode of death in severe chronic ischaemic cardiac failure.
Br Heart J, 57 (1987), pp. 125-132
[66.]
G. Cintron, G. Johnson, G. Francis, F. Cobb, J.N. Cohn.
for the V-HeFT VA Cooperative Studies Group. Prognostic significance of serial changes in left ventricular ejection fraction in patients with congestive heart failure.
Circulation, 87 (1993), pp. 17-23
[67.]
P. Lechat, S. Escolano, J.L. Golmard, H. Lardoux, S. Witchitz, J.A. Henneman, et al.
Prognostic value of bisoprolol-induced hemodynamic effects in heart failure during the Cardiac Insufficiency Bisoprolol Study (CIBIS).
Circulation, 96 (1997), pp. 2197-2205
[68.]
M.A. Quiñones, B.H. Greenberg, H.A. Kopelen, H.C. Koilpillai, M.C. Limacher, D.M. Shindler.
et al for the SOLVD Investigators. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy.
J Am Coll Cardiol, 35 (2000), pp. 1237-1244
[69.]
M. Pozzoli, E. Traversi, G. Cioffi, R. Stenner, M. Sanarico, L. Tavazzi.
Loading manipulations improve the prognostic value of doppler evaluation of mitral flow in patients with chronic heart failure.
Circulation, 95 (1997), pp. 1222-1230
[70.]
C.S. Rihal, R.A. Nishimura, L.K. Hatle, K.R. Bailey, A.J. Tajik.
Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis.
Circulation, 90 (1994), pp. 2772-2779
[71.]
S.V. Abramson, J.F. Burke, J.J. Kelly.
Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy.
Ann Int Med, 116 (1992), pp. 888-895
[72.]
D.S. Blondheim, L.E. Jacobs, M.N. Kotler, G.A. Costacurta, W.R. Parry.
Dilated cardiomyopathy with mitral regurgitation: Decreased survival despite a low frequency of left ventricular thrombus.
Am Heart J, 122 (1991), pp. 763-771
[73.]
M.J. Williams, J. Odabashian, M.S. Lauer, J.D. Thomas, T.H. Marwick.
Prognostic value of dobutamine echocardiography in patients with left ventricular dysfunction.
J Am Coll Cardiol, 27 (1996), pp. 132-139
[74.]
T.H. Lee, M.A. Hamilton, L.W. Stevenson, J.D. Moriguchi, G.C. Fonarow, J.S. Child, et al.
Impact of left ventricular cavity size on survival in advanced heart failure.
Am J Cardiol, 72 (1993), pp. 672-676
[75.]
M. Wong, G. Johnson, R. Shabetai, V. Hughes, G. Bhat, B. Lopez.
et al for the Veterans Affairs cooperative studies V-HeFT I and II. VHeFT VA Cooperative Studies Group. Echocardiographic variables as prognostic indicators and therapeutic monitors in chronic congestive heart failure.
Circulation, 87 (1993), pp. 65-70
[76.]
S.D. Anker, P. Ponikowski, S. Varney, T.P. Chua, A.L. Clark, K.M. Webb-Peploe, et al.
Wasting as independent risk factor for mortality in chronic heart failure.
Lancet, 349 (1997), pp. 1050-1053
[77.]
H. Nagaoka, N. Isobe, S. Kubota, T. Iizuka, S. Imai, T. Suzuki, et al.
Myocardial contractile reserve as prognostic determinant in patients with idiopathic dilated cardiomyopathy without overt heart failure.
Chest, 111 (1997), pp. 344-350
[78.]
T.G. Di Salvo, M. Mathier, M.J. Semigran, G.W. Dec.
Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure.
J Am Coll Cardiol, 25 (1995), pp. 1143-1153
[79.]
M.F. Di Carli, M. Davidson, R. Little, S. Khanna, F.V. Mody, R.C. Brunken, et al.
Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction.
Am J Cardiol, 73 (1994), pp. 527-533
[80.]
K.S. Lee, T.H. Marwick, S.A. Cook, R.T. Go, J.S. Fix, K.B. James, et al.
Prognosis of patients with left ventricular dysfunction, with and without viable myocardium after myocardial infarction. Relative efficacy of medical therapy and revascularization.
Circulation, 90 (1994), pp. 2687-2694
[81.]
M. Ragosta, G.A. Beller, D.D. Watson, S. Kaul, L.W. Gimple.
Quantitative planar rest-redistribution 201Tl imaging in detection of myocardial viability and prediction of improvement in left ventricular function after coronary bypass surgery in patients with severely depressed left ventricular function.
Circulation, 87 (1993), pp. 1630-1641
[82.]
S.A. Van den Broek, D.J. van Veldhuisen, P.A. de Graeff, M.L. Landsman, H. Hillege, K.I. Lie.
Comparison between New York Heart Association classification and peak oxygen consumption in the assessment of functional status and prognosis in patients with mild to moderate chronic congestive heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy.
Am J Cardiol, 70 (1992), pp. 359-363
[83.]
D.M. Mancini, H. Eisen, W. Kussmaul, R. Mull, L.H. Edmunds Jr, J.R. Wilson.
Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure.
Circulation, 83 (1991), pp. 778-786
[84.]
G. Roul, M.E. Moulichon, P. Bareiss, P. Gries, J. Sacrez, P. Germain, et al.
Exercise peak VO2 determination in chronic heart failure: is it still of value?.
Eur Heart J, 15 (1994), pp. 495-502
[85.]
J.R. Wilson, D.M. Mancini.
Factors contributing to the exercise limitation of heart failure.
J Am Coll Cardiol, 22 (1993), pp. 93A-98A
[86.]
C. Lucas, L.W. Stevenson, W. Johnson, H. Hartley, M.A. Hamilton, J. Walden, et al.
The 6-min walk and peak oxygen consumption in advanced heart failure: aerobic capacity and survival.
Am Heart J, 138 (1999), pp. 618-624
[87.]
M. Packer, A.J. Coats, M.B. Fowler, H.A. Katus, H. Krum, P. Mohacsi.
et al for the Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure.
N Engl J Med, 344 (2001), pp. 1651-1658
[88.]
M.R. Bristow, E.M. Gilbert, W.T. Abraham, K.F. Adams, M.B. Fowler, R.E. Hershberger.
et al for the MOCHA Investigators. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure.
Circulation, 94 (1996), pp. 2807-2816
[89.]
M. Packer, M.R. Bristow, J.N. Cohn, W.S. Colucci, M.B. Fowler, E.M. Gilbert.
for the U.S. Carvedilol Heart Failure Study Group. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure.
N Engl J Med, 334 (1996), pp. 1349-1355
[90.]
L.W. Stevenson, J.H. Tillisch, M. Hamilton, M. Luu, C. Chelimsky-Fallick, J. Moriguchi, et al.
Importance of hemodynamic response to therapy in predicting survival with ejection fraction less than or equal to 20% secondary to ischemic or nonischemic dilated cardiomyopathy.
Am J Cardiol, 66 (1990), pp. 1348-1354
[91.]
D. Mancini, S. Katz, L. Donchez, K. Aaronson.
Coupling of hemodynamic measurements with oxygen consumption during exercise does not improve risk stratification in patients with heart failure.
Circulation, 94 (1996), pp. 2492-2496
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