title: Mechanism of death in patients with congestive cardiac failure: the change in plasma norepinephrine and its relation to sudden death.
abstract: It has previously been observed that patients with congestive cardiac failure who die with progressive pump dysfunction tend to have higher levels of plasma norepinephrine than do patients who die suddenly and unexpectedly. However, it may be difficult to distinguish death with pump failure from sudden death. We have analyzed retrospectively 10 patients with congestive cardiac failure who clearly died suddenly and unexpectedly, and have compared them with 10 patients who clearly died of progressive pump dysfunction. Each patient had at least two sequential measurements of plasma norepinephrine before death. Patients dying of progressive pump failure tended to have a progressive rise in plasma norepinephrine from 475 to 1119 pg/ml (P less than 0.004) over an average period of 39 months. Patients dying suddenly and unexpectedly, on the other hand, had a non-significant decrease in plasma norepinephrine from 485 to 407 pg/ml over an average period of 26 months. The data suggest that an increase in plasma norepinephrine may be a marker for death from progressive pump dysfunction. This hypothesis may now be tested in two large multicenter trials where plasma norepinephrine is being monitored over time. The concept that changes in plasma norepinephrine can predict the type of death in patients with congestive cardiac failure may, if valid, be useful in clinical practice.
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis.
authors.forename: G S
authors.initials: GS
authors.lastname: Francis
authors.forename: P J
authors.initials: PJ
authors.lastname: Boosalis
mesh_terms: D003645:Death, Sudden / Q000209:etiology*; D006321:Heart / Q000503:physiopathology; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D011379:Prognosis; D013997:Time Factors
chemical_list: D009638:Norepinephrine