Madsen B K, Rasmussen V, Hansen J F
Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Denmark.
Int J Cardiol. 1997 Jan 31;58(2):151-62. doi: 10.1016/s0167-5273(96)02853-7.
One hundred and ninety consecutive patients discharged with congestive heart failure were examined with clinical evaluation, blood chemistry, 24 h Holter monitoring, exercise test and radionuclide angiography. Median left ventricular ejection fraction was 0.30, 46% were in New York Heart Association class II and 44% in III. Total mortality after 1 year was 21%, after 2 years 32%. Of 60 deaths, 33% were sudden and 49% due to pump failure. Multivariate analyses identified totally different risk factors for sudden death: ventricular tachycardia, s-sodium < or = 137 mmol/l, s-magnesium < or = 0.80 mmol/l, s-creatinine > 121 mumol/l, and maximal change in heart rate during exercise < or = 35 min-1, and for death from progressive pump failure: New York Heart Association class III + IV, delta heart rate over 24 h < or = 50 min-1, low ejection fraction, high resting p-noradrenaline, s-urea > 7.6 mmol/l, s-potassium < 3.5 mmol/l, and maximal exercise duration < or = 4 min. In conclusion, this study demonstrated different risk factors for sudden death and for death from progressive pump failure.
对190例因充血性心力衰竭出院的连续患者进行了临床评估、血液化学检查、24小时动态心电图监测、运动试验和放射性核素血管造影检查。左心室射血分数中位数为0.30，46%的患者属于纽约心脏协会II级，44%属于III级。1年后的总死亡率为21%，2年后为32%。在60例死亡病例中，33%为猝死，49%死于泵衰竭。多因素分析确定了完全不同的猝死危险因素：室性心动过速、血清钠≤137 mmol/L、血清镁≤0.80 mmol/L、血清肌酐＞121 μmol/L以及运动期间心率最大变化≤35次/分钟，以及进行性泵衰竭死亡的危险因素：纽约心脏协会III + IV级、24小时内心率变化≤50次/分钟、射血分数低、静息去甲肾上腺素高、血清尿素＞7.6 mmol/L、血清钾＜3.5 mmol/L以及最大运动持续时间≤4分钟。总之，本研究证明了猝死和进行性泵衰竭死亡的不同危险因素。
