Madsen B K, Rasmussen V, Hansen J F
Hvidovre Hospital, kardiologisk afdeling.
Ugeskr Laeger. 1999 Jan 4;161(1):34-9.
The purpose was to identify risk factors for the two most common modes of death in chronic congestive heart failure (CHF) in 190 consecutive patients discharged with CHF. They were examined with clinical evaluation, blood chemistry, chest X-ray, exercise testing, echocardiography, isotope ventriculography and Holter monitoring. Mortality after one year was 21%, after two 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. For death from progressive pump failure: New York Heart Association class 3 + 4, delta heart rate over 24 h < or = 50/min, 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.
目的是确定190例因慢性充血性心力衰竭（CHF）出院的连续患者中，CHF两种最常见死亡方式的危险因素。对他们进行了临床评估、血液化学检查、胸部X光检查、运动试验、超声心动图检查、同位素心室造影和动态心电图监测。一年后的死亡率为21%，两年后的死亡率为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。对于进行性泵衰竭导致的死亡：纽约心脏协会3+4级、24小时内心率变化≤50次/分钟、射血分数低、静息去甲肾上腺素水平高、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。
