Abstract:
OBJECTIVES:The purpose of this study was to assess the importance of syncope as a warning sign for sudden death in advanced heart failure and to determine the relative importance of cardiac syncope and syncope from other causes. BACKGROUND:Despite remarkable advances in the pharmacologic approach to advanced heart failure, 20% to 40% of patients with advanced heart failure will die each year. In such patients, the relation between sudden death and the etiology of syncope has not been evaluated. METHODS:The relation of syncope to sudden death was evaluated in 491 consecutive patients with advanced heart failure (New York Heart Association functional class III or IV), no history of cardiac arrest and a mean left ventricular ejection fraction of 0.20 +/- 0.07. Patients were evaluated for the presence and origin of syncope. The severity of heart failure was assessed from serum sodium levels, ejection fraction, functional class and echocardiographic and hemodynamic variables. RESULTS:Sixty patients (12%) had a history of syncope; the condition had a cardiac origin in 29 (48%) and was due to other causes in 31 (52%). The origin of heart failure was coronary artery disease in 234 patients (48%) and dilated cardiomyopathy in 253 (51%) and its severity was similar in patients with and without syncope. During a mean follow-up interval of 365 +/- 419 days, 69 patients (14%) died suddenly and 66 patients (13%) died of progressive heart failure. The actuarial incidence of sudden death by 1 year was significantly greater in patients with (45%) than in those without (12%, p < 0.00001) syncope. In the Cox proportional hazards model, syncope predicted sudden death independent of atrial fibrillation, serum sodium, cardiac index, angiotensin-converting enzyme inhibition and patient age. The actuarial risk of sudden death by 1 year was similarly high in patients with either cardiac syncope or syncope from other causes (49% vs. 39%, p = NS). CONCLUSIONS:Patients with advanced heart failure are at especially high risk for sudden death regardless of the etiology of syncope.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Middlekauff HR,Stevenson WG,Stevenson LW,Saxon LAdoi
10.1016/0735-1097(93)90724-fsubject
Has Abstractpub_date
1993-01-01 00:00:00pages
110-6issue
1eissn
0735-1097issn
1558-3597pii
0735-1097(93)90724-Fjournal_volume
21pub_type
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80356-x
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVES:We sought to determine which ion current predominantly affects defibrillation outcomes by using specific pharmacologic probes (lidocaine [a sodium channel blocking agent] and cesium [an outward potassium channel blocking agent]) in 26 swine. BACKGROUND:The effect of a drug on sodium or potassium channel con...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(96)00027-7
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更新日期:2003-10-01 00:00:00
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更新日期:2013-07-23 00:00:00
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更新日期:2012-12-11 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2014-02-11 00:00:00
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doi:10.1016/j.jacc.2007.04.050
更新日期:2007-08-07 00:00:00
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doi:10.1016/0735-1097(88)90283-5
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更新日期:1993-06-01 00:00:00
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更新日期:2005-05-03 00:00:00
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doi:10.1016/j.jacc.2006.03.046
更新日期:2006-08-01 00:00:00
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更新日期:1994-02-01 00:00:00
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更新日期:2017-09-05 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.jacc.2015.05.020
更新日期:2015-07-21 00:00:00
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更新日期:2005-04-05 00:00:00
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更新日期:2011-01-25 00:00:00
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更新日期:2011-10-11 00:00:00
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更新日期:1986-05-01 00:00:00
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更新日期:1995-03-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1997-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:1985-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:2002-09-04 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(86)80057-2
更新日期:1986-08-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1994-03-01 00:00:00
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更新日期:2009-06-30 00:00:00