In contrast to an overall assessment like clinical
class, requiring particular signs and symptoms as criteria
for advanced heart failure seems more problematic
(Table II). Results from the SOLVD trials reveal that the
frequency of signs and symptoms varies widely even
in patients with severe left ventricular systolic dysfunction These trials illustrate that patients with a background
therapy of digoxin and diuretics may have
advanced systolic dysfunction and yet lack a third
heart sound, edema, or cardiomegaly on chest x-ray
evaluation. Signs and symptoms of heart failure were
more consistently present in patients enrolled in FIRST,
a study of prostacyclin in patients with advanced
NYHA functional class (III or IV) and markedly
reduced left ventricular ejection fraction (