Predictors of mortality in patients hospitalized for congestive heart failure with left ventricular ejection fraction ≥ 40%

Background: There are limited data regarding the predictors of mortality in patients with acute congestive heart failure (CHF) and left ventricular ejection fraction (LVEF) >= 40%. Methods: We evaluated clinical characteristics, mortality and prognostic factors in a sample of consecutive patients hospitalized for CHF with LVEF >= 40%. Multivariable Cox regression models were developed to predict mortality using baseline clinical characteristics and echocardiographic variables. Results: The study population consisted of 191 patients, mean age 70 +/- 14.6 years (60% female) with average follow-up of 4.0 +/- 2.8 years. Cumulative 5-year mortality was 58% in the entire population and it was 59% in men and 57% in women (p = 0.411). In multivariable analyses, predictors of mortality were the following: blood urea nitrogen (BUN) > 25 mg/dL (HR = 1.77; p = 0.002); absence of hypertension (HR = 1.58; p = 0.032), left ventricular end diastolic dimension (LVEDD) <= 4.1 cm (HR = 1.73; p = 0.011) and LVEF <= 45% (HR = 1.69; p = 0.027). Conclusions: Patients hospitalized for heart failure with LVEF >= 40% have very high mortality. Absence of hypertension, elevated BUN and lower LVEF <= 45% indicate increased risk of short-and long-term mortality. Lower LVEDD is an independent predictor of mortality in heart failure patients with LVEF >= 40%.