Puddu P E, Bourassa M G, Lespérance J, Hélias J, Danchin N, Goulet C
Clin Cardiol. 1983 Aug;6(8):384-95. doi: 10.1002/clc.4960060805.
To determine whether sudden versus non-sudden cardiac death could be predicted in high risk patients, 1157 medical patients were followed for an average of 46 months after a diagnostic coronary angiogram and 18 clinical, hemodynamic, and angiographic variables known to be associated with a high risk of mortality were analyzed. The total group of 141 deaths was classified into 3 subgroups: (1) 82 sudden deaths (less than 1 hour after onset of symptoms); (2) 46 deaths due to acute myocardial infarction with or without heart failure, and (3) 13 deaths unrelated to cardiac symptoms. In a subset of 64 patients, the duration of electrical systole (QTc) was calculated before angiography and before death. A comparison was made of QTc measurements at entry with QTc values of subjects with normal coronary arteries and normal left ventricular function. Deaths from cardiac causes could often be predicted from older age, male sex, history of myocardial infarction, unstable angina, congestive heart failure, abnormal cardiothoracic ratio, multivessel disease, abnormal left ventricular contraction, and abnormal ejection fraction. However, these variables did not discriminate between sudden and nonsudden cardiac deaths and both modes of death were characterized by depressed left ventricular function and multivessel coronary disease. During follow-up the incidence of acute myocardial infarction was not different in patients with cardiac and noncardiac deaths and in long-term survivors. However, patients dying from cardiac causes had a higher incidence of heart failure. Patients dying suddenly did not present new infarctions during follow-up whereas patients dying from acute myocardial infarction had a 13% incidence of prior infarction and a higher incidence of heart failure. In addition, QTc at entry was longer in nonsurvivors than in normal subjects (p less than 0.0001) and patients experiencing sudden death exhibited the highest incidence of QTc prolongation (greater than or equal to 440 ms) during follow-up (p less than 0.05). We conclude that: (1) although the severity of coronary disease and left ventricular dysfunction are closely related to cardiac mortality, they do not discriminate between sudden and nonsudden cardiac deaths; (2) patients experiencing sudden death are characterized by a low incidence of new myocardial infarction or congestive heart failure and prolongation of the QTc interval during follow-up.
为了确定高危患者能否预测心源性猝死与非心源性猝死，对1157例内科患者在诊断性冠状动脉造影后平均随访46个月，并分析了已知与高死亡风险相关的18项临床、血流动力学和血管造影变量。141例死亡患者的总体分为3个亚组：（1）82例心源性猝死（症状发作后不到1小时）；（2）46例因急性心肌梗死伴或不伴心力衰竭死亡；（3）13例与心脏症状无关的死亡。在64例患者的亚组中，在血管造影前和死亡前计算电收缩期时长（QTc）。将入组时的QTc测量值与冠状动脉正常且左心室功能正常的受试者的QTc值进行比较。心源性死亡往往可根据年龄较大、男性、心肌梗死病史、不稳定型心绞痛、充血性心力衰竭、心胸比率异常、多支血管病变、左心室收缩异常和射血分数异常来预测。然而，这些变量无法区分心源性猝死与非心源性猝死，两种死亡方式均以左心室功能降低和多支冠状动脉病变为特征。在随访期间，心源性死亡患者与非心源性死亡患者以及长期存活者的急性心肌梗死发生率并无差异。然而，心源性死亡患者的心力衰竭发生率更高。心源性猝死患者在随访期间未出现新的梗死，而因急性心肌梗死死亡的患者既往梗死发生率为13%，心力衰竭发生率更高。此外，入组时非存活者的QTc长于正常受试者（p<0.0001），心源性猝死患者在随访期间QTc延长（≥440毫秒）的发生率最高（p<0.05）。我们得出结论：（1）尽管冠状动脉疾病的严重程度和左心室功能障碍与心源性死亡率密切相关，但它们无法区分心源性猝死与非心源性猝死；（2）心源性猝死患者的特征是随访期间新发心肌梗死或充血性心力衰竭的发生率较低以及QTc间期延长。
