Barr C S, Naas A, Freeman M, Lang C C, Struthers A D
Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee, UK.
Lancet. 1994 Feb 5;343(8893):327-9. doi: 10.1016/s0140-6736(94)91164-9.
Death in chronic heart failure (CHF) can be from progression of disease or sudden and unexpected. We have attempted to identify factors that predict sudden death in CHF. We followed up 44 patients with CHF for 12-50 (mean 36) months. 4 patients died of non-cardiovascular causes and were excluded from analysis. There were 7 sudden deaths (symptoms for less than 1 h in a previously stable patient) and 12 from progressive CHF. Patients who died of progressive CHF had lower left-ventricular ejection fractions and higher concentrations of atrial natriuretic factor than the 21 survivors, but there were no differences in these variables between survivors and those who died suddenly. However, the sudden death group had significantly (p < 0.05) greater inter-lead variability in the QT interval on the electrocardiogram (QT dispersion; 98.6 [95% CI 79.1-118] ms1/2) than survivors (53.1 [41.9-64.3] ms1/2) or the group who died from progressive CHF (66.7 [51.8-81.6] ms1/2). QT dispersion is a marker of myocardial electrical instability. The association of increased QT dispersion with sudden death suggests that patients at high risk of such death could be identified by means of this simple, reproducible test. This group might benefit from more intensive treatment.
慢性心力衰竭（CHF）患者的死亡可能源于疾病进展，也可能是突然且意外的。我们试图确定预测CHF患者猝死的因素。我们对44例CHF患者进行了12至50个月（平均36个月）的随访。4例患者死于非心血管原因，被排除在分析之外。有7例猝死（先前病情稳定的患者症状持续时间少于1小时），12例死于进行性CHF。死于进行性CHF的患者与21例幸存者相比，左心室射血分数较低，心房利钠因子浓度较高，但幸存者与猝死患者在这些变量上无差异。然而，猝死组心电图QT间期的导联间变异性（QT离散度；98.6 [95%CI 79.1 - 118] ms1/2）显著高于幸存者（53.1 [41.9 - 64.3] ms1/2）或死于进行性CHF的组（66.7 [51.8 - 81.6] ms1/2）。QT离散度是心肌电不稳定的一个指标。QT离散度增加与猝死之间的关联表明，通过这种简单、可重复的检测可以识别出此类死亡风险高的患者。这组患者可能会从更强化的治疗中获益。
