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

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 Yo rk 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 differe nt risk factors for sudden death: ventricular tachycardia, s-sodium le ss than or equal to 137 mmol/l, s-magnesium less than or equal to 0.80 mmol/l, s-creatinine>121 mu mol/l, and maximal change in heart rate d uring exercise less than or equal to 35 min(-1), and for death from pr ogressive pump failure: New York Heart Association class III+IV, Delta heart rate over 24 h less than or equal to 50 min(-1), low ejection f raction, high resting p-noradrenaline, s-urea>7.6 mmol/l, s-potassium< 3,5 mmol/l, and maximal exercise duration less than or equal to 4 min. In conclusion, this study demonstrated different risk factors for sud den death and for death from progressive pump failure. Copyright (C) 1 997 Elsevier Science Ireland Ltd.