Survival in patients with heart failure and normal basal systolic wall motion.

To assess the prognostic effect of preserved systolic function in patients with congestive heart failure (CHF), the authors analyzed survival curves in 91 nonselected adult patients with CHF. Patients were assigned to one of two groups on the basis of fractional shortening. The first group consisted of 44 patients with a normal fractional shortening (greater than 0.17), and the second group, of 47 patients with a fractional shortening of 0.17 or less. The two groups were similar in respect to all historical and physical findings. Median survival was eleven months for patients with a decreased fractional shortening and twenty-six months for patients with a normal fractional shortening. Patients with a decreased fractional shortening had a significantly shorter survival (p = 0.01). The authors conclude that congestive heart failure with preserved systolic function is common and is associated with a better prognosis, and the literature suggests it may require nonstandard therapy. Their data also suggest, however, that CHF patients with preserved systolic function cannot be reliably distinguished at the bedside. Rather, echocardiography or other tests of systolic wall motion are needed to make the diagnosis.