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

• Published in: International journal of cardiology 1997-01, Vol.58 (2), p.151-162
• Main Authors: Madsen, Bente Kühn, Rasmussen, Verner, Hansen, Jørgen Fischer
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arrhythmias, Cardiac - epidemiology; Biological and medical sciences; Cardiology. Vascular system; Cause of Death; Confidence Intervals; Congestive heart failure; Databases, Factual; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Denmark - epidemiology; Disease Progression; Electrocardiography, Ambulatory; Exercise Test - adverse effects; Female; Follow-Up Studies; Heart; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Rate - physiology; Holter monitoring; Humans; Male; Medical sciences; Middle Aged; Multivariate Analysis; Odds Ratio; Prognosis; Progressive pump failure; Prospective Studies; Regression Analysis; Risk Factors; Stroke Volume - physiology; Sudden cardiac death; Survival Analysis; Ventricular arrhythmias
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/S0167-5273(96)02853-7

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≤137 mmol/l, s-magnesium≤0.80 mmol/l, s-creatinine>121 μmol/l, and maximal change in heart rate during exercise≤35 min −1, and for death from progressive pump failure: New York Heart Association class III+IV, Δheart rate over 24 h≤50 min −1, low ejection fraction, high resting p-noradrenaline, s-urea>7.6 mmol/l, s-potassium