| Background and Objectives: As the advances in Pharmacotherapeutic strategies, many congestive heart failure(HF) patients get better therapy. But some study about the congestive heart failure’s high morbidity and mortality explain that partial heart failure patients haven’t gotten effective timely therapy and lost the survival chance. Cardiac resynchronization therapy(CRT) has been known to improve the outcome of advanced heart failure(HF) but is still underutilized in clinical practice. We selected the patients with advanced HF who were suitable for CRT but were treated with conventional strategies, collected heart function, biochemical data, Echocardiography and electrocardiogram measurements, survival time, investigated the prognosis of the patients. We also developed a risk model to predict mortality to improve the facilitation of CRT.Subjects and Methods: Patients with symptomatic HF with left ventricular ejection fraction ≤35% and QRS interval ≥120 ms were consecutively enrolled at cardiovascular hospital. After excluding those patients who had received device therapy(cardiac resynchronization therapy, automatic external defibrillator, artificial pacemaker) and cancer, 245 patients(184 males, mean 58±2years) were eventually recruited. We collected the patients’ demographics index(sex, age, body, mass index, smoke, disease type),vital-signs(heart rate, systolic blood pressure, diastolic blood pressure), Hematology-index(hemoglobin,serum creatinine,blood urea, serum potassium, hypernatremia,Brain-Natriuretic-Peptide,total-cholesterol,low density lipoprot-ein cholesterol, high density lipoprotein cholesterol),complication and drug therapy,left-ventricular-ejection-fraction,left ventricular end-diastoli-c diameter, left atrial diameter and QRS duration, statistics the mortality, survival time, malignant arrhythmia and net adverse clinical event.Results: During a follow-up of 21±3months, 63(26%) patients died. Cox single variable regression model analysis the relation of patients’ index and all-cause death, the result shows: left ventricular end-diastolic diameter≥55mm( Regression coeffcient:-0.763;hazard ratio(HR) 0.466;95% confidence interval(CI)0.255-0.852;P=0.013), serum creatinine≥132(umol/L)(0.932;HR2.539;95%CI1.396-4.620;P=0.002), heart rate>90bpm(0.829;HR2.291; 95%CI1.341-3.915;P=0.002), Beta blockers(-0.877;HR0.416;(95%CI0.241-0.719;P=0.002)had significant correlations with all-cause death. Several clear professional meaning clinical variables, such as: sex(-0.489; HR0.613; 95%CI0.360-1.045; P=0.072), chronic renal insufficiency(0.740;HR2.097;95%CI0.992-4.434;P=0.053), prior stroke( 0.447;HR1.564; 95%CI0.885-2.764; P=0.124), Atrial fibrillation(0.231;HR1.260;95%CI0.719-2.208;P=0.420), QRS duration(-0.012;HR0.988;95%CI0.974-1.001;P=0.079), hemoglobin(0.403;HR1.497;95%CI0.255-0.852;P=0.013), hypernatremia(-0.763;HR0.466;95%CI0.877-2.555;P=0.139)and left ventricular ejection fraction(0.433;HR0.466; 95%CI0.255-0.852; P=0.018).Use cox proportional hazards regression model analysis the relation of these variables and all-cause death. Heart rate >90 bpm and serum creatinine ≥132umol/L were identifed as independent factors using Cox proportional hazards regression. Based on the risk model,points were assigned to each of the risk factors proportional to the regression coeffcient, and patients were stratifed into three risk groups: low-(0), intermediate-(1), and high-risk(2 Points). According to the Kaplan-Meier method survival curves were constructed and compared, the high-risk group’s survival curves is obvious under the low-risk group’s. The 2-year survival rate of each risk group were82.1, 61.3 and 35.7 percent, respectively. Using the log-rank test comparisons of the survival rate between risk groups were significante(P<0.001). Compared with the low-risk group, the HR of the high-risk group was5.714((95% CI:2.158-15.129; P<0.001)) and intermediate-risk group was2.364(95% CI: 1.403-3.982;P=0.001). The C statistic for the risk model for prediction of mortality was 0.615.Conclusion: The study shows the high mortality of the patients with advanced HF who were suitable for CRT but were treated with conventional strategies. We developed a risk model using these factors and stratifed patients into the low-, intermediate-, and high-risk groups according to their risk score. The high-risk group demonstrated a 6-fold higher mortality risk compared to the low-risk group. The mortality of patients with advanced HF who were managed conventionally was effectively stratifed using a risk model. It may be useful for clinicians to be more proactive about adopting CRT to improve patient prognosis. |
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