Prognostic impact of metabolic syndrome in patients with chronic heart failure: data from GISSI-HF trial.

OBJECTIVES: The adverse prognostic impact of metabolic syndrome (METS) in unselected populations and in patients with coronary heart disease has been previously shown. The aim of the current analysis was to evaluate the impact of METS on prognosis in chronic heart failure (HF). METHODS: International Diabetes Federation criteria were used for the diagnosis of METS. Adjusted Cox regression models with all-cause and HF death as outcomes were fitted in 6648 patients enrolled in GISSI-HF trial with no missing values for the variables of interest. RESULTS: Risk of all-cause and HF death was significantly reduced in patients with METS compared to patients without METS (HR: 0.83, 95% CI: 0.72 to 0.95, p=0.005; HR: 0.76, 95% CI: 0.59 to 0.98, p=0.031; respectively). As compared with patients with no METS and no type 2 diabetes mellitus (DM), the risk of all-cause and HF death was significantly lower in patients with METS and no DM (HR: 0.76, 95% CI: 0.62 to 0.95, p=0.015; HR: 0.65, 95% CI: 0.42 to 0.99, p=0.046; respectively), whereas it was significantly increased in patients with DM and no METS (HR: 1.34, 95% CI: 1.21 to 1.48, p<0.001; HR: 1.44, 95% CI: 1.21 to 1.72, p<0.001; respectively). Patients with METS and DM showed no difference for risk of total and HF death compared with patients with no METS and no DM (HR: 1.03, 95% CI: 0.87 to 1.21, p=0.762; HR: 0.99; 95% CI: 0.73 to 1.35; p=0.963; respectively). CONCLUSIONS: METS is associated with reduced all-cause and HF mortality in patients with HF. HF patients with DM without METS are at the highest risk of mortality, whereas METS attenuates mortality risk in HF patients with DM.

Identification of the ischemic etiology of heart failure by cardiovascular magnetic resonance imaging: diagnostic accuracy of late gadolinium enhancement.

BACKGROUND: A large proportion of patients with heart failure (HF) have a large and poorly contracting left ventricle. The noninvasive recognition of the ischemic etiology of such patients is difficult, and for this purpose, usually patients undergo coronary angiography. It has been shown that cardiovascular magnetic resonance (CMR) imaging can detect myocardial scarring by evaluating late gadolinium enhancement (LGE). The diagnostic accuracy of such method in differentiating the etiology of HF has not been previously tested in an unselected HF ambulatory population. METHODS: We studied 60 ambulatory patients consecutively enrolled from a specialized HF clinic. We included HF patients who were found to have increased left ventricular (LV) dimensions and reduced function. CMR was performed in these patients by operators who were unaware of patients' history and clinical conditions. LV dimensions and global and regional function, as well as the pattern of LGE, were obtained in each subject. Coronary angiography was subsequently performed in all the patients. The diagnostic accuracy of clinical history and electrocardiographic patterns, as well as regional wall motion abnormalities, wall thinning, and LGE, in differentiating coronary artery disease (CAD) from non-CAD patients were evaluated. RESULTS: The majority of CAD patients (98%) showed LV contrast hyperenhancement with respect to non-CAD HF subjects (16%). The detection of LGE by CMR had a sensitivity of 98% and a specificity of 84% and an overall accuracy of 93% in detecting CAD etiology among HF patients. CONCLUSIONS: LGE is able to accurately differentiate CAD from non-CAD etiology of HF and may represent a clinically useful noninvasive tool for this purpose. As it provides relevant functional information as well as insight into the etiology, CMR may be included among the most important diagnostic tools in the workup of patients with HF.