Underlying Cause of Heart Failure Predicts Survival
April 12, 2000 (Tampa) -- Whatever causes your heart muscle to weaken and
fail also predicts how long you will live, according to a recent study. And if
doctors can predict who will live longer, they will be better able to determine
who among those waiting for a heart transplant needs a heart the most.
Heart failure is when the heart muscle doesn't pump as well as it should,
causing sufferers to feel weak, tired, or short of breath, especially with
exercise or even modest activity.
"For years, patients with unexplained heart failure have been lumped
together with the nonspecific diagnosis of 'cardiomyopathy,'" researcher
Ralph H. Hruban, MD, professor of pathology at Johns Hopkins University in
Baltimore, tells WebMD. But patients with this diagnosis had widely varying
A study of more than 1,000 patients at Johns Hopkins Hospital found that the
underlying cause of heart muscle disease causing failure helps predict how long
patients will live. The study was reported in the April 13 issue of The New
England Journal of Medicine.
"This study helps us ... to make end-of-life decisions, and to determine
the need to transplant and when," researcher Edward K. Kasper, MD, tells
WebMD. He is associate professor of medicine and director of the cardiomyopathy
and heart transplant service at Johns Hopkins. "If the patient has a type
of cardiomyopathy associated with [poor survival], I would counsel them to get
their affairs in order, and [they] might also be more likely candidates for
The study showed that five years after diagnosis, three-quarters of these
patients with heart failure caused by unknown reasons were still alive, as were
three-quarters of patients with heart failure caused by lack of oxygen to the
heart muscle. The majority of patients with heart failure related to pregnancy
were still alive five years after diagnosis.
Patients with poor survival rates included those who had heart failure as a
result of HIV, heart infections, or undergoing chemotherapy. Less than half of
these patients were still alive after five years.
"This exciting study [shows] that a heart biopsy, which is safe at
specialized centers such as Johns Hopkins, can help classify patients with
cardiomyopathy into clinically important groups," Hruban tells WebMD. Even
after biopsy, or surgical removal and microscopic examination of a small piece
of heart muscle, no definite diagnosis could be made in half the patients.
The study did not examine the effect of heart function when the patient was
first seen, nor of drugs or other treatments given, so "we can't conclude
definitively that it was diagnosis [alone] that determined survival,"
Michael M. Givertz, MD, tells WebMD when asked to review the study. He is
clinical director of the cardiomyopathy program at Boston University.