Predictors of sudden death and death from pump failure in congestive heart failure are different. Analysis of 24 h Holter monitoring, clinical variables, blood chemistry, exercise test and radionuclide angiography

Abstract

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≤137 mmol/l, s-magnesium≤0.80 mmol/l, s-creatinine>121 μmol/l, and maximal change in heart rate during exercise≤35 min −1, and for death from progressive pump failure: New York Heart Association class III+IV, Δheart rate over 24 h≤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≤4 min. In conclusion, this study demonstrated different risk factors for sudden death and for death from progressive pump failure.