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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    43 Citations (Scopus)

    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

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