Prognostic Indicators and Assessment of Therapeutic Responses

  • Daniel A. Duprez
  • Jay N. Cohn


Chronic heart failure is a debilitating and inexorably progressive disease characterized by significant morbidity and mortality. In the past 20 years, advances in understanding the pathophysiology of heart failure and new developments in treatment have allowed us to alleviate the symptoms of this disease, slow the natural progression of the underlying myocardial process, and improve survival. However, the prognosis remains generally poor, and the expanding range of therapeutic options has greatly increased the complexity of treating these patients. It has become increasingly important to identify factors that may predict clinical outcome or response to therapy, thus allowing rational selection of therapy for individual patients.


Heart Failure Brain Natriuretic Peptide Black Patient Heart Failure Hospitalization Peak Oxygen Consumption 
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  1. 1.
    Changes in mortality from heart failure: United States, 1980–1995. MMWR Morbid Mortal Wkly Rep 1998, 47: 633–637.Google Scholar
  2. 2.
    Wang TJ, Evans JC, Benjamin EJ, et al Natural history of asymptomatic left ventricular systolic dysfunction in the community. Circulation 2003, 108:977–982.Google Scholar
  3. 3.
    Baker DW, Einstadter D, Thomas C, Cebul RC: Mortality trends for 23,505 Medicare patients hospitalized with heart failure in Northeast Ohio, 1991 to 1997. Am Heart J 2003, 146: 258–264.PubMedCrossRefGoogle Scholar
  4. 4.
    Felker GM, Thompson RE, Hare JM, et al Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000, 342:1077–1084.Google Scholar
  5. 5.
    Exner DV, Dries DL, Domanski MJ, et al Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med 2001, 344:1351–1357.Google Scholar
  6. 6.
    Yancy CW, Fowler MB, Colucci WS, et al Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. N Engl J Med 2001, 344:1358–1365.Google Scholar
  7. 7.
    Adams KF, Jr., Sueta CA, Carla CA, et al Gender differences in survival in advanced heart failure: insights from the FIRST study. Circulation 1999, 99:1816–1821.Google Scholar
  8. 8.
    Bobbio M, Ferrua S, Opasich C, et al Survival and hospitalization in heart failure patients with or without diabetes treated with (3-blockers. J Cardiac Fail 2003, 9:192–202.Google Scholar
  9. 9.
    Shindler DM, Kostis JB, Yusuf S, et al Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. Am J Cardiol 1996, 77:1017–1020.Google Scholar
  10. 10.
    Anand IS, Fisher LD, Chiang YT, et al Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart FailureTrial (Val-HeFT). Circulation 2003, 107:1278–1283.Google Scholar
  11. 11.
    Cohn JN, Tognoni G, Valsartan Heart Failure Investigators: A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001, 345: 1667–1675.PubMedCrossRefGoogle Scholar
  12. 12.
    Cohn JN, Johnson GR, Shabetai R, et al Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure: the V-HeFT VA Cooperative Studies Group. Circulation 1993, 87(suppl 6):V15–V16.Google Scholar
  13. 13.
    Cintron G, Johnson G, Francis G, et al Prognostic significance of serial changes in left ventricular ejection fraction in patients with congestive heart failure: the V-HeFT VA Cooperative Studies Group. Circulation 1993, 87(6 Suppl):VI17–VI123.Google Scholar
  14. 14.
    Richards AM, Nicholls MG, Espiner EA, et al B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 2003, 107: 2786–2792.Google Scholar
  15. 15.
    Troughton RW, Frampton CM, Yandle TG, et al Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000, 355:1126–1130.Google Scholar
  16. 16.
    Latini R, Masson S, Anand I, et al The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT. Eur Heart J 2004, 25:292–299.Google Scholar
  17. 17.
    Teerlink JR, Jalaluddin M, Anderson S, et al Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. PROMISE (Prospective Randomized Milrinone Survival Evaluation) Investigators. Circulation 2000, 101:40–46.Google Scholar
  18. 18.
    Buxton AE, Lee KL, Fisher JD, et al A randomized study of the prevention of sudden death in patients with coronary artery disease: Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 1999, 341:1882–1890.Google Scholar
  19. 19.
    Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA: Six minute walking test for assessing exercise capacity in chronic heart failure. Br Med J (Clin Res Ed) 1986, 292: 653–655.CrossRefGoogle Scholar
  20. 20.
    Rector TS, Kubo SH, Cohn JN: Validity of the Minnesota Living with Heart Failure questionnaire as a measure of therapeutic response to enalapril or placebo. Am J Cardiol 1993, 71: 1106–1107.PubMedCrossRefGoogle Scholar
  21. 21.
    Rector TS, Cohn JN: Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J 1992, 124: 1017–1025.Google Scholar
  22. 22.
    Carson P, Tognoni G, Cohn JN: Effect of valsartan on hospitalization: results from Val-HeFT. J Card Fail 2003, 9: 164–171.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2005

Authors and Affiliations

  • Daniel A. Duprez
  • Jay N. Cohn

There are no affiliations available

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