Echocardiographic variables as prognostic indicators and therapeutic monitors in chronic congestive heart failure: Veterans affairs cooperative studies V-HeFT I and II

Maylene Wong, Gary Johnson, Ralph Shabetai, Vincent Hughes, Geetha Bhat, Becky Lopez, Jay N. Cohn

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Background. Echocardiographic indexes of ventricular function have become indispensable in clinical cardiology but have not been tested as prognostic markers or therapeutic monitors in clinical trials. In two Veterans Administration trials on heart failure (Vasodilator-Heart Failure Trials I and II, V-HeFT I and II), echocardiographic variables were analyzed as predictors and monitors and were compared with other indicators of cardiac performance. Methods and Results. Echocardiograms were recorded before randomization and at follow-up intervals. Baseline measurements of left ventricular internal diameters (LVIDd, LVIDs), wall thickness (THd, THs), radius to thickness ratios (Rd/THd, Rs/THs), and mitral E-point septal separation (EPSS) were evaluated as predictors of mortality individually, in multivariate regression models with each other, and with nonechocardiographic predictors. Within-subject changes were compared between treatment groups. Cumulative survival curves were compared between strata formed by cut-points of EPSS and Rs/THs data. In Cox regression analyses, EPSS, LVIDs, and Rs/THs were significant predictors of mortality. In V-HeFT I, Rd/THd was a predictor in the presence of ejection fraction and peak oxygen uptake. In patients with EPSS ≥21, there was an 83% increase in mortality in the subgroup of patients with Rs/THs ≥2.5 compared with Rs/THs <2.5 (p=0.003), whereas there was no statistical difference for EPSS <21. EPSS showed improvement in patients treated with hydralazine-isosorbide dinitrate compared with placebo at 2 and 18 months and a trend toward deterioration between 36 and 66 months. In V-HeFT II, there were no differences between enalapril and hydralazine-isosorbide dinitrate groups at follow-up. Conclusions. Echocardiographic variables, EPSS, LVIDs, and Rs/THs were shown to be predictors of mortality and monitors of treatment for heart failure in clinical trials.

Original languageEnglish (US)
JournalCirculation
Volume87
Issue number6 SUPPL. 1
StatePublished - Jun 1993

Fingerprint

Veterans
Heart Failure
Isosorbide Dinitrate
Hydralazine
Mortality
Clinical Trials
United States Department of Veterans Affairs
Enalapril
Ventricular Function
Therapeutics
Random Allocation
Cardiology
Treatment Failure
Vasodilator Agents
Placebos
Regression Analysis
Oxygen
Survival

Keywords

  • Echocardiography
  • Heart failure
  • Prognosis

Cite this

Echocardiographic variables as prognostic indicators and therapeutic monitors in chronic congestive heart failure : Veterans affairs cooperative studies V-HeFT I and II. / Wong, Maylene; Johnson, Gary; Shabetai, Ralph; Hughes, Vincent; Bhat, Geetha; Lopez, Becky; Cohn, Jay N.

In: Circulation, Vol. 87, No. 6 SUPPL. 1, 06.1993.

Research output: Contribution to journalArticle

Wong, Maylene ; Johnson, Gary ; Shabetai, Ralph ; Hughes, Vincent ; Bhat, Geetha ; Lopez, Becky ; Cohn, Jay N. / Echocardiographic variables as prognostic indicators and therapeutic monitors in chronic congestive heart failure : Veterans affairs cooperative studies V-HeFT I and II. In: Circulation. 1993 ; Vol. 87, No. 6 SUPPL. 1.
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T1 - Echocardiographic variables as prognostic indicators and therapeutic monitors in chronic congestive heart failure

T2 - Veterans affairs cooperative studies V-HeFT I and II

AU - Wong, Maylene

AU - Johnson, Gary

AU - Shabetai, Ralph

AU - Hughes, Vincent

AU - Bhat, Geetha

AU - Lopez, Becky

AU - Cohn, Jay N.

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N2 - Background. Echocardiographic indexes of ventricular function have become indispensable in clinical cardiology but have not been tested as prognostic markers or therapeutic monitors in clinical trials. In two Veterans Administration trials on heart failure (Vasodilator-Heart Failure Trials I and II, V-HeFT I and II), echocardiographic variables were analyzed as predictors and monitors and were compared with other indicators of cardiac performance. Methods and Results. Echocardiograms were recorded before randomization and at follow-up intervals. Baseline measurements of left ventricular internal diameters (LVIDd, LVIDs), wall thickness (THd, THs), radius to thickness ratios (Rd/THd, Rs/THs), and mitral E-point septal separation (EPSS) were evaluated as predictors of mortality individually, in multivariate regression models with each other, and with nonechocardiographic predictors. Within-subject changes were compared between treatment groups. Cumulative survival curves were compared between strata formed by cut-points of EPSS and Rs/THs data. In Cox regression analyses, EPSS, LVIDs, and Rs/THs were significant predictors of mortality. In V-HeFT I, Rd/THd was a predictor in the presence of ejection fraction and peak oxygen uptake. In patients with EPSS ≥21, there was an 83% increase in mortality in the subgroup of patients with Rs/THs ≥2.5 compared with Rs/THs <2.5 (p=0.003), whereas there was no statistical difference for EPSS <21. EPSS showed improvement in patients treated with hydralazine-isosorbide dinitrate compared with placebo at 2 and 18 months and a trend toward deterioration between 36 and 66 months. In V-HeFT II, there were no differences between enalapril and hydralazine-isosorbide dinitrate groups at follow-up. Conclusions. Echocardiographic variables, EPSS, LVIDs, and Rs/THs were shown to be predictors of mortality and monitors of treatment for heart failure in clinical trials.

AB - Background. Echocardiographic indexes of ventricular function have become indispensable in clinical cardiology but have not been tested as prognostic markers or therapeutic monitors in clinical trials. In two Veterans Administration trials on heart failure (Vasodilator-Heart Failure Trials I and II, V-HeFT I and II), echocardiographic variables were analyzed as predictors and monitors and were compared with other indicators of cardiac performance. Methods and Results. Echocardiograms were recorded before randomization and at follow-up intervals. Baseline measurements of left ventricular internal diameters (LVIDd, LVIDs), wall thickness (THd, THs), radius to thickness ratios (Rd/THd, Rs/THs), and mitral E-point septal separation (EPSS) were evaluated as predictors of mortality individually, in multivariate regression models with each other, and with nonechocardiographic predictors. Within-subject changes were compared between treatment groups. Cumulative survival curves were compared between strata formed by cut-points of EPSS and Rs/THs data. In Cox regression analyses, EPSS, LVIDs, and Rs/THs were significant predictors of mortality. In V-HeFT I, Rd/THd was a predictor in the presence of ejection fraction and peak oxygen uptake. In patients with EPSS ≥21, there was an 83% increase in mortality in the subgroup of patients with Rs/THs ≥2.5 compared with Rs/THs <2.5 (p=0.003), whereas there was no statistical difference for EPSS <21. EPSS showed improvement in patients treated with hydralazine-isosorbide dinitrate compared with placebo at 2 and 18 months and a trend toward deterioration between 36 and 66 months. In V-HeFT II, there were no differences between enalapril and hydralazine-isosorbide dinitrate groups at follow-up. Conclusions. Echocardiographic variables, EPSS, LVIDs, and Rs/THs were shown to be predictors of mortality and monitors of treatment for heart failure in clinical trials.

KW - Echocardiography

KW - Heart failure

KW - Prognosis

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