Cosín Aguilar J, Bayés de Luna A, Navarro López F, Navarro Lima A
Servicio de Cardiología, Hospital La Fe, Valencia.
Rev Esp Cardiol. 1996 Oct;49(10):732-40.
Our study was designed with the primary objective of evaluating the cardiac, overall and sudden mortality in patients with class IV heart failure (NYHA) managed with standard treatment and captopril (50 mg/8 hr. max.).
95 consecutive patients were enrolled in 21 hospitals and were followed for 6 months in order to design an interventional clinical trial to reduce sudden death.
Death occurred in 14 patients (14.7%; i.c. 8.3% - 23.5%; p < 0.05). There were no non-cardiovascular deaths in the group. There were 6 sudden death cases (42.9%; i.c. 16.9% - 68.8%, p < 0.05). Patients who died had a higher baseline end-diastolic (p < 0.05) and end-systolic (p < 0.01) diameter of the left ventricle (LV) and lower values of systolic (p < 0.01) and diastolic (p < 0.05) blood pressure. During the follow-up phase, heart rate, ventricular premature contraction, blood pressure and LV diameters decreased significantly in the whole group (p < 0.05, p < 0.001). We found no any differences during the follow-up phase between the patients who died and those who survived. In the patients who died we found no any differences between sudden death cases and the other death cases.
Sudden death was less frequent than we had expected and due to this fact it is impossible for us to design an interventional trial.
我们开展这项研究的主要目的是评估接受标准治疗及卡托普利（最大剂量50毫克/8小时）治疗的IV级心力衰竭（纽约心脏协会分级）患者的心脏死亡率、总死亡率和猝死率。
21家医院连续纳入了95例患者，并对其进行了6个月的随访，以设计一项降低猝死率的干预性临床试验。
14例患者死亡（14.7%；即8.3% - 23.5%；p < 0.05）。该组无非心血管死亡病例。有6例猝死病例（42.9%；即16.9% - 68.8%，p < 0.05）。死亡患者的左心室舒张末期（p < 0.05）和收缩末期（p < 0.01）直径基线较高，收缩压（p < 0.01）和舒张压（p < 0.05）值较低。在随访阶段，全组患者的心率、室性早搏、血压和左心室直径均显著下降（p < 0.05，p < 0.001）。我们发现在随访阶段，死亡患者与存活患者之间没有任何差异。在死亡患者中，我们发现猝死病例与其他死亡病例之间没有任何差异。
猝死的发生率低于我们的预期，因此我们无法设计一项干预性试验。
