Predictors of sudden death and death from pump failure in congestive heart failure are different. Analysis of 24 h Holter monitoring, clinical variables, blood chemistry, exercise test and radionuclide angiography.
One hundred and ninety consecutive patients discharged with congestive heart failure were examined with clinical evaluation, blood chemistry, 24 h Holter monitoring, exercise test and radionuclide angiography. Median left ventricular ejection fraction was 0.30, 46% were in New York Heart Association class II and 44% in III. Total mortality after 1 year was 21%, after 2 years 32%. Of 60 deaths, 33% were sudden and 49% due to pump failure. Multivariate analyses identified totally different risk factors for sudden death: ventricular tachycardia, s-sodium < or = 137 mmol/l, s-magnesium < or = 0.80 mmol/l, s-creatinine > 121 mumol/l, and maximal change in heart rate during exercise < or = 35 min-1, and for death from progressive pump failure: New York Heart Association class III + IV, delta heart rate over 24 h < or = 50 min-1, low ejection fraction, high resting p-noradrenaline, s-urea > 7.6 mmol/l, s-potassium < 3.5 mmol/l, and maximal exercise duration < or = 4 min. In conclusion, this study demonstrated different risk factors for sudden death and for death from progressive pump failure.
Madsen
B K
BK
Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark.
Rasmussen
V
V
Hansen
J F
JF
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D002423:Cause of Death; D016001:Confidence Intervals; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis