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Sudden cardiac death risk factors in patients with heart failure treated with carvedilol

Nessler, Jadwiga; Nessler, Bohdan; Kitlinski, Mariusz LU ; Libionka, Anna; Kubinyi, Ateksander; Konduracka, Ewa and Piwowarska, Wieslawa (2007) In Kardiologia Polska 65(12). p.1417-1424
Abstract
Background: Chronic heart failure (CHF) is associated with a high risk of sudden cardiac death (SCID). Most frequently SCID occurs in patients with NYHA class II and III. Aim: To evaluate the influence of prolonged carvedilol therapy on SCID risk in CHF patients. Methods: The study included 86 patients (81 men and 5 women) aged 56.8 +/- 9.19 (35-70) years with CHF in NYHA class II and III receiving an ACE inhibitor and diuretics but not beta-blockers. At baseline and after 12 months of carvedilol therapy the following risk factors for SCID were analysed: in angiography - occluded infarct-related artery; in echocardiography - left ventricular ejection fraction (LVEF) < 30%, volume of the left ventricle (LVEDV) > 140 ml; in ECG at rest... (More)
Background: Chronic heart failure (CHF) is associated with a high risk of sudden cardiac death (SCID). Most frequently SCID occurs in patients with NYHA class II and III. Aim: To evaluate the influence of prolonged carvedilol therapy on SCID risk in CHF patients. Methods: The study included 86 patients (81 men and 5 women) aged 56.8 +/- 9.19 (35-70) years with CHF in NYHA class II and III receiving an ACE inhibitor and diuretics but not beta-blockers. At baseline and after 12 months of carvedilol therapy the following risk factors for SCID were analysed: in angiography - occluded infarct-related artery; in echocardiography - left ventricular ejection fraction (LVEF) < 30%, volume of the left ventricle (LVEDV) > 140 ml; in ECG at rest - sinus heart rate (HRs) > 75/min, sustained atrial fibrillation, increased QTc; in 24-hour ECG recording - complex arrhythmia, blunted heart rate variability (SDNN < 100 ms) and abnormal turbulence parameters (TO and TS or one of them); in signal-averaged ECG - late ventricular potentials and prolonged QRS > 114 ms. The analysis of SCD risk factors in basic examination in patients who suddenly died was also performed. Results: During one-year carvedilol therapy heart transplantation was performed in 2 patients; 5 patients died. At 12 months the following risk factors for SCID were significantly changed: HRs > 75/min (50 vs. 16 patients, p=0.006), LVEF < 30% (37 vs. 14 patients, p=0.01), SDNN < 100 ms (19 vs. 9 patients, p=0.04). At 12 months the number of risk factors for SCD in each patient was significantly reduced (p=0.001). In patients who suddenly died we found a greater amount of SCID risk factors in basic examination (7 vs. 5) as compared to alive patients. Conclusions: Prolonged beta-adrenergic blockade reduces risk of sudden cardiac death through significant LVEF increase, reduction of HR at rest and improvement of HRV. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
heart rate turbulence, ejection fraction, late potentials, heart rate variability, rate, heart, risk factors, carvedilol, sudden cardiac death, heart failure
in
Kardiologia Polska
volume
65
issue
12
pages
1417 - 1424
publisher
Polskie Towarzystwo Kardiologiczne
external identifiers
  • wos:000254491200002
  • scopus:38049158368
ISSN
1897-4279
language
English
LU publication?
yes
id
600b9cce-66e9-49f7-809d-faccd4c27eb1 (old id 1407195)
date added to LUP
2009-06-03 10:05:44
date last changed
2017-07-23 03:48:21
@article{600b9cce-66e9-49f7-809d-faccd4c27eb1,
  abstract     = {Background: Chronic heart failure (CHF) is associated with a high risk of sudden cardiac death (SCID). Most frequently SCID occurs in patients with NYHA class II and III. Aim: To evaluate the influence of prolonged carvedilol therapy on SCID risk in CHF patients. Methods: The study included 86 patients (81 men and 5 women) aged 56.8 +/- 9.19 (35-70) years with CHF in NYHA class II and III receiving an ACE inhibitor and diuretics but not beta-blockers. At baseline and after 12 months of carvedilol therapy the following risk factors for SCID were analysed: in angiography - occluded infarct-related artery; in echocardiography - left ventricular ejection fraction (LVEF) &lt; 30%, volume of the left ventricle (LVEDV) &gt; 140 ml; in ECG at rest - sinus heart rate (HRs) &gt; 75/min, sustained atrial fibrillation, increased QTc; in 24-hour ECG recording - complex arrhythmia, blunted heart rate variability (SDNN &lt; 100 ms) and abnormal turbulence parameters (TO and TS or one of them); in signal-averaged ECG - late ventricular potentials and prolonged QRS &gt; 114 ms. The analysis of SCD risk factors in basic examination in patients who suddenly died was also performed. Results: During one-year carvedilol therapy heart transplantation was performed in 2 patients; 5 patients died. At 12 months the following risk factors for SCID were significantly changed: HRs &gt; 75/min (50 vs. 16 patients, p=0.006), LVEF &lt; 30% (37 vs. 14 patients, p=0.01), SDNN &lt; 100 ms (19 vs. 9 patients, p=0.04). At 12 months the number of risk factors for SCD in each patient was significantly reduced (p=0.001). In patients who suddenly died we found a greater amount of SCID risk factors in basic examination (7 vs. 5) as compared to alive patients. Conclusions: Prolonged beta-adrenergic blockade reduces risk of sudden cardiac death through significant LVEF increase, reduction of HR at rest and improvement of HRV.},
  author       = {Nessler, Jadwiga and Nessler, Bohdan and Kitlinski, Mariusz and Libionka, Anna and Kubinyi, Ateksander and Konduracka, Ewa and Piwowarska, Wieslawa},
  issn         = {1897-4279},
  keyword      = {heart rate turbulence,ejection fraction,late potentials,heart rate variability,rate,heart,risk factors,carvedilol,sudden cardiac death,heart failure},
  language     = {eng},
  number       = {12},
  pages        = {1417--1424},
  publisher    = {Polskie Towarzystwo Kardiologiczne},
  series       = {Kardiologia Polska},
  title        = {Sudden cardiac death risk factors in patients with heart failure treated with carvedilol},
  volume       = {65},
  year         = {2007},
}