Heart rate variations during isoproterenol infusion in congestive heart failure: relationships to cardiac mortality.
A marked derangement of heart rate modulation in patients with severe cardiac heart failure (CHF) has been reported. The purpose of the study was to correlate the variations of sinus cycle length (SCL) during infusion of 4 micrograms/min of isoproterenol with the prognosis of 83 patients with CHF (mean left ventricular ejection fraction 28 +/- 9%). During a mean follow-up of 28 +/- 9 months, nine patients died from CHF (group I), nine died suddenly (group II), and 65 are alive (group III). Compared with groups II and III, a significantly weaker ejection fraction (20 +/- 8% versus 29.5 +/- 11% and 28 +/- 9%), a smaller control state SCL (571 +/- 65 versus 722 +/- 200 and 747 +/- 195), and a smaller percentage of SCL shortening during isoproterenol infusion (11.5 +/- 7% versus 36 +/- 16% and 33 +/- 13%) were noted in group I. The sensitivity and specificity of a percentage of SCL shortening during isoproterenol infusion less than or equal to 15% for predicting death from CHF were 89% and 93%, respectively. Therefore the injection of small doses of isoproterenol (4 micrograms/min) may be proposed to evaluate the prognosis of patients with CHF; a weak increase in heart rate during this infusion is a sign of bad prognosis with a high risk of cardiac death as a result of CHF.
Brembilla-Perrot
B
B
CHU Brabois, Vandoeuvre Les Nancy, France.
D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D007545:Isoproterenol / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity
D007545:Isoproterenol