DiBianco R
Department of Cardiology, Washington Adventist Hospital, Takoma Park, Maryland.
Herz. 1991 Sep;16 Spec No 1:318-23.
Progression of heart failure ("expected mortality") and sudden cardiac death ("unexpected mortality"), presumably secondary to ventricular arrhythmia, are the major causes for the poor prognosis in chronic heart failure (CHF). Limitations of this classification ultimately stem from inaccuracies in establishing the mechanism of death at the time of death. Elucidation of the determinants of patients prone to sudden death and the effects of treatment modalities on the rate of sudden death remain hidden. Unexpected mortality is probably secondary to arrhythmic death but denotes only that death occurred within some brief interval (arbitrarily less than one hour in most studies) and does not exclude other causes. The demonstrated benefit of ACE inhibitors for improving total mortality as illustrated by the findings of the VHeFT, Captopril Multicenter and CONSENSUS, and the improved event-free survival shown by Munich Mild Heart Failure Trial for low-dose captopril argues strongly for their use in patients with CHF. These agents are confirmed to reduce the risk of death from pump failure; the effects on sudden death are less clear. Although many favorable effects contribute to improved hemodynamics, neuroendocrine and electrolyte status as discussed, at present, it is not possible to predict the precise mechanism by which these agents extend life and whether they reduce the frequency of "sudden" deaths.
心力衰竭进展（“预期死亡率”）和心源性猝死（“意外死亡率”），推测继发于心室心律失常，是慢性心力衰竭（CHF）预后不良的主要原因。这种分类的局限性最终源于死亡时确定死亡机制的不准确。阐明易发生猝死的患者的决定因素以及治疗方式对猝死发生率的影响仍然不明。意外死亡率可能继发于心律失常性死亡，但仅表示死亡发生在某个短暂间隔内（大多数研究中任意设定为少于一小时），并不排除其他原因。VHeFT、卡托普利多中心研究和CONSENSUS研究结果表明，ACE抑制剂对改善总死亡率具有显著益处，慕尼黑轻度心力衰竭试验中低剂量卡托普利显示出改善无事件生存期，这些都有力地支持了在CHF患者中使用ACE抑制剂。这些药物已被证实可降低泵衰竭导致的死亡风险；对猝死的影响尚不清楚。尽管如前所述，许多有利作用有助于改善血流动力学、神经内分泌和电解质状态，但目前尚无法预测这些药物延长生命的确切机制，以及它们是否能降低“突然”死亡的发生率。
