Symptoms vs. pathology and outcomes in patients with reduced ejection fraction

Abstract Background After acute myocardial infarction (AMI), patients have similar mortality regardless of whether AMI is silent or not. Less is known about whether outcomes after left ventricular systolic dysfunction (LVSD) varies by absence or presence of heart failure (HF) symptoms (Stage B and C HF, respectively). Methods In Studies of Left Ventricular Dysfunction (SOLVD), patients with EF ≤35% were randomized to enalapril or placebo. We compared 4-year mortality in 2569 patients with HF symptoms (Stage C HF) enrolled in SOLVD-Treatment trial with that in 4228 patients without symptoms (Stage B) in SOLVD-Prevention trial, adjusting for 24 baseline characteristics including age, sex, race, EF, symptoms (as indexed by NYHA class). Results Patients in SOVLD-Treatment had a higher risk of death (HR, 2.63; 95% CI, 2.37–2.90; p<0.001), which remained significant after adjustment for 23 covariates except NYHA (HR, 1.35; 95% CI, 1.16–1.60; p<0.001; Figure, left panel). However, when NYHA was added to the model, the significant was lost (adjusted HR, 1.15; 95% CI, 0.97–1.36; p = 0.117; Figure, right panel). Conclusion These findings suggest that unlike in patients with AMI, in patients with reduced EF, those with HF symptoms have higher mortality, even after adjustment for other covariates.