Predicting sudden death in patients with mild to moderate chronic heart failure

• Published in: Heart (British Cardiac Society) Vol. 90; no. 10; pp. 1137 - 1143
• Main Authors: Kearney, M T, Fox, K A A, Lee, A J, Brooksby, W P, Shah, A M, Flapan, A, Prescott, R J, Andrews, R, Batin, P D, Eckberg, D L, Gall, N, Zaman, A G, Lindsay, H S, Nolan, J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-10-2004; BMJ; BMJ Publishing Group LTD; Copyright 2004 by Heart
• Subjects: Acute coronary syndromes; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; arrhythmias; Biological and medical sciences; Cardiac arrhythmia; Cardiology. Vascular system; Cardiomegaly - complications; Cardiomegaly - physiopathology; Cardiovascular disease; Cardiovascular Medicine; CHF; Chronic Disease; chronic heart failure; Classification; confidence interval; Death, Sudden - etiology; Diabetes; Electrocardiography; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Epidemiologic Methods; Family physicians; Female; Heart; Heart attacks; Heart failure; Heart Failure - complications; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Intensive care medicine; MADIT II; Male; Medical sciences; Middle Aged; Mortality; multicentre automatic defibrillator implantation trial II; New York Heart Association; NYHA; Patients; Population; prognosis; QT interval corrected for rate; QTc; receiver operating characteristic; risk stratification; ROC; Studies; sudden death; Tachycardia, Ventricular - complications; Tachycardia, Ventricular - physiopathology; UK-HEART; United Kingdom-heart failure evaluation and assessment of risk trial; United Kingdom > UK; Human; Heart failure; Cardiovascular disease; Chronic; Heart disease; Sudden death
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2003.021733

Objectives: To explore the relation between non-invasive measures of cardiac function and sudden cardiac death, as well as the development and utility of an index integrating these variables to identify patients at increased risk of this mode of death. Design: UK-HEART (United Kingdom-heart failure evaluation and assessment of risk trial) was a prospective study conducted between December 1993 and April 2000. The study was specifically designed to identify non-invasive markers of death and mode of death among patients with chronic heart failure. Setting: 8 UK general hospitals. Main outcome measures: Death and mode of death. Results: 553 patients aged a mean (SD) of 63 (10) years, in New York Heart Association functional class 2.3 (0.02), recruited prospectively. After 2365 patient-years’ follow up, 201 patients had died (67 suddenly). Predictors of sudden death were greater cardiothoracic ratio, QRS dispersion, QT dispersion corrected for rate (QTc) across leads V1–V6 on the 12 lead ECG, and the presence of non-sustained ventricular tachycardia. The hazard ratio and 95% confidence intervals (CI) of sudden death for a 10% increase in cardiothoracic ratio was 1.43 (95% CI 1.20 to 1.71), for a 10% increase in QRS dispersion 1.11 (95% CI 1.04 to 1.19), for the presence of non-sustained ventricular tachycardia 2.03 (95% CI 1.27 to 3.25), and for a 10% increase in QTc dispersion across leads V1–V6 1.03 (95% CI 1.00 to 1.07) (all p < 0.04). An index derived from these four factors performed well in identifying patients specifically at increased risk of sudden death. Conclusions: Results show that an index derived from three widely available non-invasive investigations has the potential to identify ambulant patients with chronic heart failure at increased risk of sudden death. This predictive tool could be used to target more sophisticated investigations or interventions aimed at preventing sudden death.