Objectives The disease pattern underlying acute congestive heart failure (AHF) has been changing recently in Korea. In the past years, hypertensive heart disease (HHD) and dilated cardiomyopathy (DCMP) were the major causes of AHF. Increasing the incidence and prevalence of ischemic heart disease (IHD) dramatically, it became the main cause of AHF. IHD patients with AHF may show the different clinical manifestations, but only a few studies about that in Korea. We investigated the clinical characteristics and prognosis of IHD presenting as AHF. Methods From Jan 1st 2005 to Dec 31st 2007, 144 patients with AHF admitted to our hospital. Among them, 54 patients (38%) with IHD (76.4±9.9 yrs), 32 patients (22%) with HHD (75.4±11.9 yrs) and 20 patients (14%) with DCMP (69.4±19.5 yrs) were included in this study. Results NYHA functional class was not different among 3 groups. More patients in IHD presented with sinus rhythm on the initial ECG. Maximum troponin T (TnT) and NT-proBNP were more elevated in IHD group. Left ventricular ejection fraction was lowest and regional wall motion score index (RWSI) was highest in DCMP group. The E/A ratio of the mitral inflow was highest in DCMP group, but the proportion of patients with restrictive left ventricular filling pattern was not statistically different. In-hospital mortality was 6% in IHD group, 0% in HHD group, and 5% in DCMP group (p=0.41). IHD group showed the highest 1 year mortality (27.8% vs. HHD 3.1% & DCMP 15.0%; p=0.0087). At 1 year, more patients in DCMP group readmitted with AHF (40.0% vs. IHD 29.6% & HHD 18.8%; p=0.099). 1 year event rate was lowest in HHD group (18.8%; p=0.019), but similar between IHD (42.6%) and DCMP group (45.0%). Conclusions IHD was the main underlying cause of AHF. Comparing with HHD and DCMP groups, in-hospital mortality of AHF in IHD group were not significantly different, but they had high long-term mortality and morbidity.
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