• P Carson, G Johnson, R Fletcher, and J Cohn.
• Department of Cardiology, Veterans Affairs Medical Center, Washington, D.C. 20422, USA.
• J. Am. Coll. Cardiol. 1996 Mar 1; 27 (3): 642-9.

ObjectivesThis analysis sought to evaluate the clinical characteristics and outcome in heart failure with mild systolic dysfunction.BackgroundAlthough heart failure with mild systolic dysfunction occurs commonly, this is an understudied area because clinical trials have usually excluded patients with ejection fraction >35%.MethodsThe 422 patients with left ventricular ejection fraction 35% in the Vasodilator in Heart Failure Trial (V-HeFT I), whereas in V-HeFT-II 554 patients with a left ventricular ejection fraction 35% for mortality and clinical care. For a left ventricular ejection fraction >35%, treatment with hydralazine/isosorbide dinitrate was compared with prazosin and placebo therapy in V-HeFT I, and hydralazine/isosorbide dinitrate was compared with enalapril in V-HeFT II for mortality, clinical course and change in physiologic variables: ejection fraction, plasma norepinephrine levels, ventricular tachycardia and echocardiographic variables.ResultsIn both studies, patients with a left ventricular ejection fraction >35% differed principally in hypertensive history, higher functional capacity and radiographic and echocardiographic cardiac dimension from patients with a left ventricular ejection fraction 35% had a lower cumulative mortality than those with a left ventricular ejection fraction ConclusionsIn V-HeFT, heart failure with mild systolic dysfunction was associated with different characteristics and a more favorable prognosis than heart failure with more severe systolic dysfunction. Enalapril decreased overall mortality and sudden death compared with hydralazine/isosorbide dinitrate. Prospective trials are needed to address therapy for heart failure with mild systolic dysfunction.

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