Author + information
- Received August 3, 1994
- Revision received December 12, 1994
- Accepted December 15, 1994
- Published online May 1, 1995.
- Al Hallstrom, PhDa,*,
- Craig M. Pratt, MD, FACC*,
- H. Leon Greene, MD, FACCa,
- Melissa Huthera,
- Stephen Gottlieb, MD, FACC†,
- Anthony DeMaria, MD, FACC‡,
- James B. Young, MD, FACCa,
- for the Cardiac Arrhythmia Suppression Trial Investigators
- ↵*Address for correspondence: Dr. Al Hallstrom, Clinical Trial Center, University of Washington, JD-22, 1107 NE 45th Street, Room 505, Seattle, Washington 98105.
Objectives. We studied the relations between heart failure, ejection fraction, arrhythmia suppression and mortality.
Background. Both left ventricular ejection fraction and functional class of heart failure are strongly associated with mortality after acute myocardial infarction. Both are also related to the presence of ventricular arrhythmias and have been identified as factors related to the ability to suppress ventricular arrhythmias. Little has been reported about the relations between these two factors and arrhythmia suppression or mortality.
Methods. Baseline data from the Cardiac Arrhythmia Suppression Trial were used to define several categories of heart failure and to relate both the resulting categories and ejection fraction to arrhythmia suppression and mortality using logistic and survival regression analytic methodologies.
Results. Regardless of the prospective baseline definition of heart failure used, the data consistently showed that heart failure was a more powerful predictor of subsequent congestive heart failure events and arrhythmia suppression and was equally powerful in predicting death. However, each variable provided incremental information when included in the prediction model. Heart failure and ejection fraction appeared to be independent predictors of death. Interactions were observed: A low ejection fraction was more predictive of failure of arrhythmia suppression in patients with than without evidence of heart failure before or at baseline; a low ejection fraction was more predictive of subsequent congestive heart failure events in patients without than with evidence of heart failure before or at baseline.
Conclusions. Although heart failure as a prognostic feature appears to be somewhat superior to ejection fraction, both are powerful predictors of arrhythmia suppression and cardiac events in patients with ventricular arrhythmia after myocardial infarction. Each provides incremental prediction.
This study was supported by Contract NO1 HC-65042 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. It was presented in part at the 64th Annual Scientific Sessions of the American Heart Association, November 1991.
- Received August 3, 1994.
- Revision received December 12, 1994.
- Accepted December 15, 1994.
- American College of Cardiology