Moser D K, Stevenson W G, Woo M A, Stevenson L W
School of Nursing, University of California, Los Angeles.
J Am Coll Cardiol. 1994 Oct;24(4):963-7. doi: 10.1016/0735-1097(94)90856-7.
The purpose of this study was to determine the timing of sudden death in patients with advanced heart failure.
The frequency of sudden cardiac death and myocardial infarction is greatest in the morning hours, suggesting that physiologic processes associated with morning activities may trigger these events. In patients with advanced heart failure, a variety of mechanisms may cause sudden death, and the frequency of their occurrence may differ from that in other patient groups, perhaps altering the timing of sudden death in heart failure.
Deaths among 566 consecutive patients followed up after treatment for advanced heart failure were prospectively categorized as sudden death, death due to heart failure or noncardiac death. For 72 sudden deaths the time of death was determined from witnesses to the event and from death certificates.
Sudden death occurred 2.5 times more frequently between 6:01 AM and 12 noon than in the three other 6-h intervals, with 46% of deaths occurring during this period (p < 0.005). The morning peak occurred both in patients with coronary artery disease and in those with nonischemic causes of heart failure.
Despite a variety of potential mechanisms of sudden death and underlying causes of heart disease in patients with heart failure, the 24-h distribution of sudden death in these patients is similar to that observed in other patient groups. Morning surges in sympathetic nervous system activity may promote a variety of sudden death mechanisms, including ischemic and nonischemic arrhythmias.
本研究旨在确定晚期心力衰竭患者猝死的时间。
心源性猝死和心肌梗死的发生率在早晨时段最高，这表明与早晨活动相关的生理过程可能引发这些事件。在晚期心力衰竭患者中，多种机制可能导致猝死，其发生频率可能与其他患者群体不同，这或许会改变心力衰竭患者猝死的时间。
对566例接受晚期心力衰竭治疗后进行随访的连续患者的死亡情况进行前瞻性分类，分为猝死、因心力衰竭死亡或非心源性死亡。对于72例猝死患者，根据事件目击者和死亡证明确定死亡时间。
上午6:01至中午12点之间猝死的发生率比其他三个6小时时间段高出2.5倍，46%的死亡发生在此期间（p<0.005）。冠状动脉疾病患者和非缺血性心力衰竭病因患者均出现早晨高峰。
尽管心力衰竭患者存在多种潜在的猝死机制和心脏病潜在病因，但这些患者猝死的24小时分布与其他患者群体相似。交感神经系统活动的早晨激增可能会促进多种猝死机制，包括缺血性和非缺血性心律失常。
