CLINICAL STUDIES
Circadian rhythm and sudden death in heart failure
Results from prospective randomized amlodipine survival trial
Peter A. Carson, MD, FACC*,
Christopher M. O’Connor, MD, FACC ,
Alan B. Miller, MD, FACC ,
Susan Anderson, PhD ,
Robert Belkin, MD, FACC||,
Gerald W. Neuberg, MD, FACC¶,
John H. Wertheimer, MD, FACC**,
David Frid, MD,
Anne Cropp and
Milton Packer, MD, FACC¶
* VA Medical Center, Washington, DC, USA
Duke University Medical Center, Durham, North Carolina, USA
University of Florida, Jacksonville, Florida, USA
University of Wisconsin, Madison, Wisconsin, USA
|| Valhalla, New York, New York, USA
¶ Columbia University, New York, New York, USA
** Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
Ohio State University, Columbia, Ohio, USA
Pfizer Inc., Groton, Connecticut, USA
Manuscript received February 16, 1999;
revised manuscript received January 26, 2000,
accepted March 30, 2000.
Reprint requests and correspondence: Dr. Peter Carson, Department of Cardiology, 151D, Washington VA Medical Center, 50 Irving Street, NW, Washington, DC 20422-001
OBJECTIVE
The purpose of this study was to address the timing of sudden death in advanced heart failure patients.
BACKGROUND
Sudden death is a catastrophic event in cardiovascular disease. It has a circadian pattern prominent in the early AM, which has been thought to be due to a surge of sympathetic stimulation. We postulated that the distribution of events in advanced heart failure, with chronic sympathetic activation, would be more uniform implicating other potential mechanisms.
METHODS
We analyzed data from Prospective Randomized Amlodipine Survival Trial (PRAISE). Sudden deaths were analyzed by time of death in 4-h and 1-h blocks for uniformity of distribution in the entire cohort, and in the prespecified ischemic and nonischemic stratum. Further analyses were undertaken in the treatment groups of amlodipine and placebo, and among those receiving background therapy of aspirin and warfarin.
RESULTS
Sudden deaths in the overall cohort showed a nonuniform distribution with a PM peak but not an AM peak. The ischemic stratum also showed a PM peak, but sudden deaths within the nonischemic stratum were uniformly distributed. Neither amlodipine treatment nor aspirin or warfarin use altered the distribution.
CONCLUSIONS
Sudden death in advanced heart failure did not show an AM peak, suggesting that circadian sympathetic activation did not strongly influence these events. The PM peak noted is likely complex in origin and was not affected by antiischemic or antithrombotic medications.
|
Abbreviations and Acronyms
| | ASIST | = Atenolol Silent Ischemia Study | | BHAT | = Beta Blocker Heart Attack Trial | | CASS | = Coronary Artery Surgery Study | | CAST | = Cardiac Arrhythmia Suppression Trial | | PRAISE | = Prospective Randomized Amlodipine Survival Evaluation |
|
This article has been cited by other articles:
|
|
|
|
 
B. Marcheva, K. M. Ramsey, A. Affinati, and J. Bass
Clock genes and metabolic disease
J Appl Physiol,
November 1, 2009;
107(5):
1638 - 1646.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. L. Verrier and M. E. Josephson
Impact of Sleep on Arrhythmogenesis
Circ Arrhythm Electrophysiol,
August 1, 2009;
2(4):
450 - 459.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Durgan, M. W. S. Moore, N. P. Ha, O. Egbejimi, A. Fields, U. Mbawuike, A. Egbejimi, C. A. Shaw, M. S. Bray, V. Nannegari, et al.
Circadian rhythms in myocardial metabolism and contractile function: influence of workload and oleate
Am J Physiol Heart Circ Physiol,
October 1, 2007;
293(4):
H2385 - H2393.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Durgan, N. A. Trexler, O. Egbejimi, T. A. McElfresh, H. Y. Suk, L. E. Petterson, C. A. Shaw, P. E. Hardin, M. S. Bray, M. P. Chandler, et al.
The Circadian Clock within the Cardiomyocyte Is Essential for Responsiveness of the Heart to Fatty Acids
J. Biol. Chem.,
August 25, 2006;
281(34):
24254 - 24269.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. Young
The circadian clock within the heart: potential influence on myocardial gene expression, metabolism, and function
Am J Physiol Heart Circ Physiol,
January 1, 2006;
290(1):
H1 - H16.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kadish, A. Dyer, J. P. Daubert, R. Quigg, N.A. M. Estes, K. P. Anderson, H. Calkins, D. Hoch, J. Goldberger, A. Shalaby, et al.
Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy
N. Engl. J. Med.,
May 20, 2004;
350(21):
2151 - 2158.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. H. Reisin, N. Pancheva, M. Berman, V. Khalameizer, J. Jafary, C. Yosefy, Y. Blaer, I. Manevich, R. Peled, and S. Scharf
Circadian Variation of the Efficacy of Thrombolytic Therapy in Acute Myocardial Infarction--Isn't the Time Ripe for Cardiovascular Chronotherapy?
Angiology,
May 1, 2004;
55(3):
257 - 263.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. L. DeMets and R. M. Califf
Lessons Learned From Recent Cardiovascular Clinical Trials: Part II
Circulation,
August 13, 2002;
106(7):
880 - 886.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. DeMets and R. M. Califf
Lessons Learned From Recent Cardiovascular Clinical Trials: Part I
Circulation,
August 6, 2002;
106(6):
746 - 751.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. Young, P. Razeghi, A. M. Cedars, P. H. Guthrie, and H. Taegtmeyer
Intrinsic Diurnal Variations in Cardiac Metabolism and Contractile Function
Circ. Res.,
December 7, 2001;
89(12):
1199 - 1208.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
