Mortality in cardiac insufficiency. Evaluation of prognosis, influence of treatments
Komajda, M.; Grosgogeat, Y.
Archives des Maladies du Coeur et des Vaisseaux 83(13): 1975-1980
1990
ISSN/ISBN: 0003-9683 PMID: 2125417 Document Number: 365075
Chronic cardiac failure is associated with a high mortality from refractory cardiac failure or sudden death. Several factors (etiology, clinical severity, hemodynamic parameters, degree of left ventricular dilatation, biological parameters, conduction defects and arrhythmias) seem to have a predictive value for mortality in this condition. Univariable analysis does not take into account any interrelation between these parameters. Therefore multivariable analysis should be used to assess the independent predictive value of a given factor on mortality. Most published studies in the medical literature concern patients in severe cardiac failure. It is not clear whether the identified factors of poor prognosis can be extrapolated to mild cardiac failure. The influence of treatment on the clinical course of cardiac failure is not well understood: favorable effects of vasodilators, converting enzyme inhibitors, no or unfavorable effects of positive inotropic agents, unknown effects (diuretics, digitalis, betablockers). Only randomised, multicentre therapeutic trials in comparable groups of patients can provide information about the effects of medical treatment on the long-term prognosis of cardiac failure.