No abstract

The significance of heart-rate turbulence (HRT) in patients with chronic heart failure (CHF) was evaluated to examine whether it is sensitive to the risk of ventricular tachycardia (VT). HRT is reported to predict the prognosis after myocardial infarction (MI), but its prognostic value in patients with CHF remains unknown. HRT was measured in 50 CHF patients (left ventricular ejection fraction <50% and/or left ventricular end-diastolic diameter >55 mm, 34 cardiomyopathy, 16 post-MI) and 21 patients without obvious heart diseases (control). HRT slope and HRT onset were measured by the original definitions using digitized Holter ECG recordings. Cardiac pump function was assessed by echocardiography. The value of the HRT slope was significantly lower in CHF than in control (3.7 +/- 1.7 vs 16.4 +/- 5.3, mean +/- SD, p < 0.01). The value of the HRT onset in patients with CHF was significantly higher than that in control patients (-1.1 +/- 1.9 vs -3.6 +/- 1.7, mean +/- SD, p < 0.05). The HRT slope and onset in CHF patients with VT were nearly identical to those without VT. The HRT slope appears to be a powerful prognostic marker that shows significant differences between CHF subgroups when divided by clinical events; that is, CHF death and CHF hospitalization. However, it has limited value for predicting fatal ventricular arrhythmias.

yocardial infarction (MI) is an important cardiovascular disease in terms of its severity and incidence. As in other industrialized countries, it is a major public health problem in Japan. Left ventricular (LV) remodeling after MI exacerbates LV dysfunction and causes chronic heart failure (CHF) that is generally progressive. 1 However, the real prognosis of Japanese patients with CHF caused by an underlying MI is still unknown. Many studies indicate that the prevention and improvement of LV remodeling by angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB) orblocker (BB) significantly improves the prognosis of CHF patients after MI. [2][3][4] The 3 objectives of the present study were: (1) to compare the prognoses of CHF patients following MI with those of CHF patients with nonischemic cardiomyopathy (NICM) using our CHF registry, (2) to clarify the prognoses of CHF patients with preserved systolic LV function or fewer CHF symptoms in the MI cohort, and (3) to determine the independent predictors of outcome, including ACEI/ARB or BB. Circulation Journal Vol.69, February 2005 Methods Patient PopulationIn February 2000, we started a hospital-based CHF registry called the Chronic Heart Failure Registry and Analysis in the Tohoku District (CHART) in order to perform epidemiological analyses of Japanese patients with CHF. Member hospitals, associate physicians, and the design of the CHART registry have been described elsewhere. 5,6 Oral or written informed consent was obtained from each patient and the study protocol, which was approved by the human research committee of Tohoku University School of Medicine, conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Patients were enrolled when at least one of the following criteria was met: (1) LV ejection fraction (LVEF) was less than 50%, (2) LV end-diastolic diameter (LVDD) was equal to or more than 55 mm, or (3) at least one episode of congestive heart failure. All recruited patients had a structural disorder of the heart and were treated with standard therapy for CHF, including diuretics, digitalis, ACEI, ARB, or BB to maintain their ability to perform the activities of daily life without severe symptoms. Although our CHF criteria were relatively broader than the 'traditional' CHF criteria, we recruited less symptomatic patients with preserved systolic LV function and therefore we might have included Stage B patients, based on the new CHF classification proposed by the 2001 ACC/AHA guidelines. 1 As of February 2003, 1,154 CHF patients were enrolled in the registry and the mean follow-up period was 1.9±0.9 (mean ± SD) years. From that group, the study population comprised 283 CHF Background Myocardial infarction (MI) is one of the major etiologies of chronic heart failure (CHF) in Japan. Methods and ResultsThe prognoses of CHF patients after MI (n=283) were investigated by comparing them with those of CHF patients with nonischemic cardiomyopathy (NICM, n=310) from the CHF registry (CHART; n=1,154). The Kaplan-Meier (KM...

Background: Sudden death is common in chronic heart failure (CHF). Risk stratification is the first step for primary prevention. Aim: To evaluate the use of risk markers for estimating sudden death risk. Methods and results: We prospectively examined 680 stable patients with CHF. Risk markers were evaluated using the Cox's proportional hazard model in a stepwise manner. Ejection fraction < 30%, left ventricular end-diastolic diameter > 60 mm, brain natriuretic peptide > 200 pg/ml, non-sustained ventricular tachycardia, and diabetes were significantly associated with increased risk of sudden death. When the number of risk markers were included as co-variables, only ''number of risk markers 3µ entered the model (hazard ratio 8.95, 95% confidence interval 4.57 -17.52), while the effects of individual markers did not enter the model. The annual mortality from sudden death was 11% in patients with 3 or more risk markers and 1.4% in patients with 2 or less. Conclusions: Rather than particular risk markers, the number of accumulated risk markers was a more powerful predictor for sudden death in patients with CHF. The number of risk markers could be useful for risk stratification of sudden death.

The study was designed to characterize patients with chronic heart failure (CHF) in Japan in terms of the etiologies and prognosis. CHF was defined by ejection fraction (EF >or=50%), left ventricular diastolic dimension (LVDD >or=55 mm) or a past history of congestive heart failure. Among the 721 recruited patients, the most frequent etiology for CHF was dilated cardiomyopathy (DCM) in patients aged less than 59 years, and valvular heart disease (VHD) in those aged 70 years or more. The 1-year crude mortality was 8% overall and 12% in patients with myocardial infarction (MI). Sudden death accounted for 40% of the total deaths among all patients, and 60% in patients with MI. Multivariate logistic regression analysis showed that brain natriuretic peptide (BNP) was a consistent prognostic marker in CHF patients with a variety of etiologies. Total death and hospitalization because of heart failure were significantly less frequent in patients with BNP less than 100 pg/ml. In conclusion, the etiologies of Japanese CHF appear to be more diverse than those of other Western countries, but BNP is an excellent prognostic marker despite the etiological diversity. Sudden, unexpected death in CHF patients is also a serious problem in Japan. A nation-wide epidemiologic study should be done to characterize Japanese CHF.