Of Heart Failure Caused By The Sudden Death Of Heart Electrical, And Serological Warning And Risk Assessment

Background Chronic heart failure (CHF) is a major public health issue worldwide. Although nearly20years, CHF research has made great progress in prevention and control measures and to improve the prognosis of heart failure, the incidence and prevalence rate is still high in China, epidemiological research is still blank about sudden cardiac death caused by CHF. In our study, the multi-center, large prospective studies will reveal the status of the prognosis of heart failure.Materials and methods From July2005to December2009,consecutive patients with chronic heart failure referred from13hospitals were recruited including Fu Wai Hospital, People's Hospital of Peking University and First People's Hospital of Jiangsu Province et al. Inclusion criteria were:chronic heart failure caused by ischemic heart disease arising from coronary artery disease or chronic heart failure caused by idiopathic dilated cardiomyopathy; symptomatic heart failure with New York Heart Association (NYHA) functional class Ⅱ-Ⅳ despite optimized medical therapy and left ventricular systolic dysfunction with a left ventricular ejection fraction (LVEF)≦50%in ischemic heart disease and≦45%in dilated cardiomyopathy. Controls were selected from radiofrequency ablation for supraventricular tachycardia without structural heart disease and community-based inhabitants who underwent an annual health examination and were free of structural heart disease and any type of cardiac arrhythmias. After follow-up during regular out-patient clinics or through telephone contact as well as by mail, to investigate the mortality in all-cause death and sudden cardiac death, further analyze the risk factors of SCD using univariate and logistic multivariate analysis.Results A total of2368chronic heart failure patients and824control subjects were enrolled in this prospective study. During a median follow-up period of38months in2038(86.06%) patients,451patients died from heart failure, of whom171(37.91%) were sudden cardiac death. Sudden death rate was8.39%, non-sudden death rate was13.73%, the overall mortality rate was22.12%in follow-up period. The proportion of male patients with SCD was significantly higher than women (79.53%vs20.47%, p <0.001), average ages were no significant difference between the gender in sudden cardiac patients.(Male:57.74±13.13year, Female:58.85±13.26year, p>0.05); totally, with increasing age the total mortality of heart failure was rising, but with other age groups,60-70-year-old heart failure patients were more susceptible to SCD; In addition, compared with n-SCD, a history of sustained ventricular tachycardia and ventricular fibrillation attack, LVEF=30%and NYHA Ⅱ/Ⅲ patients were more susceptible to SCD (all p<0.05).Conclusions With the increasing age, the overall mortality of heart failure was rising, this trend has nothing to do with gender, but male, a history of sustained ventricular tachycardia and ventricular fibrillation attack, and patients with LVEF≦30%and NYHA Ⅱ/Ⅲ were prone to SCD. Background Heart failure (HF) and sudden cardiac death (SCD) seriously threatened healthy and life of the patients. In china, the mortality of HF including27%-39%prevalence of SCD. accounted for about40%of total mortality in the hospital. SCD in CHF mostly occurred NYHA Ⅱ and Ⅲ of patients and died of malignant wentricular arrhythmias. So it has important clinical significance to estimate prognosis of these patients using sample and convenient noninvasive techniques. We therefore investigated whether J wave, fQRS wave and long Tp-Te interval on a routine12-lead electrocardiogram were related to the risk of SCD in patients with CHF so that to establish effectively preventive strategy and reduce the prevalence of SCD.Materials and methods From July2005to December2009,consecutive patients with CHF referred from13hospitals were recruited including Fu Wai Hospital, People's Hospital of Peking University and First People's Hospital of Jiangsu Province et al. Inclusion criteria were:CHF caused by ischemic heart disease arising from coronary artery disease or CHF caused by idiopathic dilated cardiomyopathy; symptomatic heart failure with New York Heart Association (NYHA) functional class II-IV despite optimized medical therapy and left ventricular systolic dysfunction with a left ventricular ejection fraction (LVEF)≦50%in ischemic heart disease and≦45%in dilated cardiomyopathy. Controls were selected from community-based inhabitants who underwent an annual health examination and were free of structural heart disease and any type of cardiac arrhythmias. The gender ratio was matched with the cases. According to the existence of J wave, fQRS wave and Tp-Te interval on the12-lead ECG, multivariate logistic regression analysis, Cox proportional-hazards models and survival analysis were used to analyze the association between indicators on ECG and endpoint in patients.Results A total of1847CHF patients and822control subjects were enrolled in this prospective study. During a median follow-up period of36months (0.4-65months) in1570(85.0%) patients,438(27.89%) patients died from HF, of whom151(35.84%) patients were SCD Overall, the occurrence of J wave, fQRS and long Tp-Te interval were greater in SCD patients than that of non-SCD (NSCD) patients (all p<0.01). For DCM cases, more SCD patients had J waves observed in the inferior leads than that in the NSCD group (26.78%vs.13.07%, p<0.001). However, ICM cases with SCD did have more fQRS in the inferior leads than that with NSCD (42.16%vs.26.67%, p=0.01). After adjusting for other risk factors, Cox regression analysis revealed that presence of J wave or fQRS in the inferior leads predicted a higher risk for SCD in DCM (HR,4.095;95%CI,2.132-7.863) and ICM (HR,2.714;95%CI,1.809-4.072) patients. A LVEF≦30%also predicted SCD and NSCD in DCM and ICM patients. By contrast, the predictive value of QTc and Tp-Te for SCD was not significant.Conclusions Presence of J wave or fQRS in the inferior leads predicted higher risk of SCD in DCM and ICM patients and might serve independent predictors for SCD in patients with CHF. Background Clinical and animal studies suggest that β1-adrenergic and M2muscarinic receptor autoantibodies (β1-AAbs and M2-AAbs) play important roles in the pathophysiological process of chronic heart failure (CHF). Removal of these autoantibodies improved hemodynamic parameters and left ventricular ejection fraction of those patients. CC-AAbs played an important role in the pathogenesis of VT in dilated cardiomyopathy. The goal of this project is to evaluate whether β1-AAbs, M2-AAbs and CC-AAbs predict prognosis and sudden cardiac death (SCD) in patients with CHF.Materials and methods From July2005to December2009,consecutive patients with CHF referred from13hospitals were recruited including Fu Wai Hospital, People's Hospital of Peking University and First People's Hospital of Jiangsu Province et al. Inclusion criteria were:CHF caused by ischemic heart disease arising from coronary artery disease or CHF caused by idiopathic dilated cardiomyopathy; symptomatic heart failure with New York Heart Association (NYHA) functional class Ⅱ-Ⅳ despite optimized medical therapy and left ventricular systolic dysfunction with a left ventricular ejection fraction (LVEF)≦50%in ischemic heart disease and≦45%in dilated cardiomyopathy. Controls were selected from community-based inhabitants who underwent an annual health examination and were free of structural heart disease and any type of cardiac arrhythmias. The gender ratio was matched with the cases. Peptides corresponding to the amino acid sequence of the second extracellular loop of the human β1-AR as well as the amino acid sequence of the second extracellular loop of the human M2-AAbs and the sequence of α1c/CaV1.2of the human L-type calcium channel were synthesized and using ELISA method to detect the autoantibody. According to the presence of β1-AAbs, M2-AAbs and CC-AAbs, multivariate logistic regression analysis, Cox proportional-hazards models and survival analysis were used to analyze the correlation between these autoantibodies and the prognosis of CHFResults A total of2062patients with CHF and824control subjects were recruited. During a median follow-up period of36months (0.40～65months),379(21.56%) cases died-164had dilated cardiomyopathy (DCM) and215had ischemic cardiomyopathy (ICM). Of them,69cases (40.37%) of DCM and84cases (39.07%) of ICM had SCD. The positive rate of β1-AAbs in DCM and ICM was significantly higher than that of the control (8.1%and8.25%versus2.2%, both p<0.01). The positive rate of CC-AAbs in ICM group was significant higher than that in control group (4.07%vs.1.21%, p<0.05). However, positive rate of M2-AAbs did not show any statistical difference between the three groups. Cox regression analysis revealed that positive β1-AAbs was associated with higher mortality in CHF and that it predicted SCD for DCM (HR=4.51,95%CI2.405-8.471) and ICM (HR3.749with95%CI2.389-5.884) patients meanwhile the positive CC-AAbs was associated with all-cause death (HR with2.684for95%CI1.737-4.037) and SCD (HR=2.947,95%CI1.575-5.513).but β1-AAbs and CC-AAbs not Non-SCD (NSCD).Conclusions The positive rate of β1-AAbs and CC-AAbs was higher in CHF patients than in the controls. Positive β1-AAbs and CC-AAbs might serve as an independent predictor for SCD in the patients with CHF.