Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study

A M A Shehab, R J MacFadyen, M McLaren, R Tavendale, J J F Belch, A D Struthers

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    Abstract

    Objective: To see whether sudden unexpected death in chronic heart failure is preceded by intraindividual
    worsening in inflammation and in ECG criteria.
    Design and setting: Prospective cohort study conducted in the community.
    Patients: 34 patients with chronic heart failure were studied. Their mean (SD) age was 68 (8) years, 29
    were men, mean (SD) left ventricular ejection fraction was 29 (9)%, and they were in New York Heart
    Association functional class II (n = 20), III (n = 11), and IV (n = 3). The patients were examined monthly
    over 24 months, with sequential measurement of C reactive protein and neutrophil counts and 24 hour
    ambulatory ECG monitoring measuring heart rate variability, mean heart rate, and arrhythmias.
    Intraindividual changes in these parameters were related to subsequent cardiac deaths.
    Results: During follow up, nine patients died: five patients had a sudden unexpected death (SUD) and four
    died of progressive heart failure (PHF). There were significant intraindividual changes in neutrophil counts
    (p = 0.02), C reactive protein (p = 0.039), and heart rate variability (p ( 0.018) in those who died of
    SUD and PHF. In contrast no significant changes were seen in ventricular extrasystoles, ventricular
    tachycardia episodes, brain natriuretic peptide, or aldosterone in the SUD group, but all of these
    parameters did increase as expected in those who died of PHF.
    Conclusions: This is preliminary evidence that SUD may be preceded by intraindividual increases in both
    inflammation and autonomic dysfunction. Both may be causal in genesis but, even if they are not,
    intraindividual increases in either may be convenient markers to identify patients at high risk of impending
    SUD. Larger studies are needed to confirm the observation from this pilot study.
    Original languageEnglish
    Pages (from-to)1263-8
    Number of pages6
    JournalHeart (British Cardiac Society)
    Volume90
    Issue number11
    DOIs
    Publication statusPublished - 2004

    Fingerprint

    Sudden Death
    Heart Failure
    Inflammation
    Heart Rate
    C-Reactive Protein
    Electrocardiography
    Neutrophils
    Ventricular Premature Complexes
    Brain Natriuretic Peptide
    Aldosterone
    Stroke Volume
    Cardiac Arrhythmias
    Cohort Studies
    Observation
    Prospective Studies

    Cite this

    @article{c6bb090529e148f4b3f76819a7cb00c3,
    title = "Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study",
    abstract = "Objective: To see whether sudden unexpected death in chronic heart failure is preceded by intraindividualworsening in inflammation and in ECG criteria.Design and setting: Prospective cohort study conducted in the community.Patients: 34 patients with chronic heart failure were studied. Their mean (SD) age was 68 (8) years, 29were men, mean (SD) left ventricular ejection fraction was 29 (9){\%}, and they were in New York HeartAssociation functional class II (n = 20), III (n = 11), and IV (n = 3). The patients were examined monthlyover 24 months, with sequential measurement of C reactive protein and neutrophil counts and 24 hourambulatory ECG monitoring measuring heart rate variability, mean heart rate, and arrhythmias.Intraindividual changes in these parameters were related to subsequent cardiac deaths.Results: During follow up, nine patients died: five patients had a sudden unexpected death (SUD) and fourdied of progressive heart failure (PHF). There were significant intraindividual changes in neutrophil counts(p = 0.02), C reactive protein (p = 0.039), and heart rate variability (p ( 0.018) in those who died ofSUD and PHF. In contrast no significant changes were seen in ventricular extrasystoles, ventriculartachycardia episodes, brain natriuretic peptide, or aldosterone in the SUD group, but all of theseparameters did increase as expected in those who died of PHF.Conclusions: This is preliminary evidence that SUD may be preceded by intraindividual increases in bothinflammation and autonomic dysfunction. Both may be causal in genesis but, even if they are not,intraindividual increases in either may be convenient markers to identify patients at high risk of impendingSUD. Larger studies are needed to confirm the observation from this pilot study.",
    author = "Shehab, {A M A} and MacFadyen, {R J} and M McLaren and R Tavendale and Belch, {J J F} and Struthers, {A D}",
    year = "2004",
    doi = "10.1136/hrt.2003.028399",
    language = "English",
    volume = "90",
    pages = "1263--8",
    journal = "Heart",
    issn = "1355-6037",
    publisher = "BMJ Publishing Group",
    number = "11",

    }

    TY - JOUR

    T1 - Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction

    T2 - a pilot study

    AU - Shehab, A M A

    AU - MacFadyen, R J

    AU - McLaren, M

    AU - Tavendale, R

    AU - Belch, J J F

    AU - Struthers, A D

    PY - 2004

    Y1 - 2004

    N2 - Objective: To see whether sudden unexpected death in chronic heart failure is preceded by intraindividualworsening in inflammation and in ECG criteria.Design and setting: Prospective cohort study conducted in the community.Patients: 34 patients with chronic heart failure were studied. Their mean (SD) age was 68 (8) years, 29were men, mean (SD) left ventricular ejection fraction was 29 (9)%, and they were in New York HeartAssociation functional class II (n = 20), III (n = 11), and IV (n = 3). The patients were examined monthlyover 24 months, with sequential measurement of C reactive protein and neutrophil counts and 24 hourambulatory ECG monitoring measuring heart rate variability, mean heart rate, and arrhythmias.Intraindividual changes in these parameters were related to subsequent cardiac deaths.Results: During follow up, nine patients died: five patients had a sudden unexpected death (SUD) and fourdied of progressive heart failure (PHF). There were significant intraindividual changes in neutrophil counts(p = 0.02), C reactive protein (p = 0.039), and heart rate variability (p ( 0.018) in those who died ofSUD and PHF. In contrast no significant changes were seen in ventricular extrasystoles, ventriculartachycardia episodes, brain natriuretic peptide, or aldosterone in the SUD group, but all of theseparameters did increase as expected in those who died of PHF.Conclusions: This is preliminary evidence that SUD may be preceded by intraindividual increases in bothinflammation and autonomic dysfunction. Both may be causal in genesis but, even if they are not,intraindividual increases in either may be convenient markers to identify patients at high risk of impendingSUD. Larger studies are needed to confirm the observation from this pilot study.

    AB - Objective: To see whether sudden unexpected death in chronic heart failure is preceded by intraindividualworsening in inflammation and in ECG criteria.Design and setting: Prospective cohort study conducted in the community.Patients: 34 patients with chronic heart failure were studied. Their mean (SD) age was 68 (8) years, 29were men, mean (SD) left ventricular ejection fraction was 29 (9)%, and they were in New York HeartAssociation functional class II (n = 20), III (n = 11), and IV (n = 3). The patients were examined monthlyover 24 months, with sequential measurement of C reactive protein and neutrophil counts and 24 hourambulatory ECG monitoring measuring heart rate variability, mean heart rate, and arrhythmias.Intraindividual changes in these parameters were related to subsequent cardiac deaths.Results: During follow up, nine patients died: five patients had a sudden unexpected death (SUD) and fourdied of progressive heart failure (PHF). There were significant intraindividual changes in neutrophil counts(p = 0.02), C reactive protein (p = 0.039), and heart rate variability (p ( 0.018) in those who died ofSUD and PHF. In contrast no significant changes were seen in ventricular extrasystoles, ventriculartachycardia episodes, brain natriuretic peptide, or aldosterone in the SUD group, but all of theseparameters did increase as expected in those who died of PHF.Conclusions: This is preliminary evidence that SUD may be preceded by intraindividual increases in bothinflammation and autonomic dysfunction. Both may be causal in genesis but, even if they are not,intraindividual increases in either may be convenient markers to identify patients at high risk of impendingSUD. Larger studies are needed to confirm the observation from this pilot study.

    U2 - 10.1136/hrt.2003.028399

    DO - 10.1136/hrt.2003.028399

    M3 - Article

    C2 - 15486117

    VL - 90

    SP - 1263

    EP - 1268

    JO - Heart

    JF - Heart

    SN - 1355-6037

    IS - 11

    ER -