Prognostic value of left ventricular function in ischemic heart disease symptomatic patient over 65 years

pp 29-34

Abstract

This study was performed to evaluate the prognostic value of LV function in symptõmãtic coronary artery disease (CAD) patients over 65 years of age. We studied 75 patients with symptomatic CAD and previous documented acute myocardial infarction (AMI), and/or positive stress test, and/or significant éoronary artery lesions documented by coronary angiography. Clinical parameters were analyzed and L V function was assessed by measuring left ventricular ejection fraction (LVEF) by radionuclide angiography. Patients were followed for a period of 24 months and were. divided into two groups: group A: 36 patients (L VEF < 40%), and group B: 39 patients (LVEF> 60%). Mean resting LVEF in group A was 27.9%. This group showed higher incidence of cardiomegaly and previous AMI. The exercise L VEF in 20 of the 36 patients that were able to performed it showed slight increase (comparable to normal patients). In group B (mean resting L VEF 67.8%) 36 patients were able to exercise and their L VEF fell significantly from the control resting state (-5.7%). At two years of follow up, the findings were as follow: group A had a high and early mortality -47%- (70% of it during the 1st. semester); mortality in group B was low -2.6%-, late (18th month) and not related to CAD. The functional classification of the survival patients at two years was similar in both groups. We conclude that: 1) LVEF measured by radio nuclide angiography in symptomatic CAD patients over 65 years of age can separate high and low risk groups. 2) In the high risk group (EF < 40%) mortality. is very high and early (within 6 months of the determination). 3) Low risk patients have excellent survival rates. From this data it ap- pears justified to offer aggressive therapy to those patients with high risk in spite of their age.