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Aims Identification of patients with congestive heart failure at risk of sudden death remains problematic and few data are available on the prognostic implications of QT dispersion. We sought to assess the predictive value of QT dispersion for arrhythmic events in heart failure secondary to dilated cardiomyopathy or ischaemic heart disease. Methods and Results Twelve-lead ECGs calculated for QT dispersion, 24h Holter ECGs and signal-averaged ECGs were prospectively recorded in 205 heart failure patients in sinus rhythm. The 86 patients with ischaemic heart disease and the 119 with dilated cardiomyopathy were not significantly different as regards NYHA grades (51 vs 49% in grades III–IV), cardiothoracic ratio (57±7 vs 57±6%) and ejection fraction (28±8 vs 29±9%). The mean QT dispersion (66±29 vs 65±27ms), the frequency of non-sustained ventricular tachycardia (37 vs 38%) and ventricular late potentials (41 vs 40%) were not significantly different in patients with ischaemic or dilated cardiomyop-athy. QT dispersion was not significantly related to other arrhythmogenic markers. During follow-up (24±16 months), 66 patients died, 22 of them died suddenly and seven presented a spontaneous sustained ventricular tachycardia. In patients with dilated cardiomyopathy, in multivariate analysis, only a QT dispersion >80ms was an independent predictor of sudden death (RR: 4·9, 95% CI 1·4–16·8,P<0·02) and arrhythmic events (RR: 4·5, 95% CI 1·5–13·5,P<0·01). In patients with ischaemic heart disease, no studied parameter was found significantly related to sudden death or arrhythmic events. Conclusion: In congestive heart failure, abnormal QT dispersion can identify patients with dilated cardiomyopathy who are at high risk of arrhythmic events. [ABSTRACT FROM PUBLISHER]

Congestive heart failure is frequently associated with an increase in peripheral resistance induced by stimulation of the renin angiotensin system and of the sympathetic nervous system. The clinical, biological and hemodynamic effects of Captopril (SQ 14225), an oral inhibitor of angiotensin converting enzyme, were measured in 20 patients with heart failure poorly controlled by digitalis,diuretics and vasodilator therapy. After two months of Captopril administration from 150 to 250 mg per day, NYHA functional class improved from 34 to 206 (P<0.01). Heart rate decreased from 84.20 ± 17.46 to 76.26 ± 15.86 beats/min (mean ± standard error of the mean), (P<0.05). Mean arterial pressure was not significantly reduced from 89.25 ± 17.21 to 82.70 ± 10.86 mm Hg. Systemic vascular resistance decreased from 2234 ± 560 to 1680 ± 381 dynes scm (P<0.001), and pulmonary wedge pressure fell from 20.25 ± 7.10 to 14.60 ± 5.96 mm Hg fP<0.001). Cardiac index rose from 1.91 ± 0.41 to 2.37 ± 0.55 l/min/m (P<0.001) and stroke work index also increased from 23.62 ± 9.78 to 33.35 ± 14.48 g/syst/m. Plasma renin activity increased from 2.08 ± 2.99 to 6.73 ± 3.98 ng/mlh (P<0.001), and plasma aldosterone level fell from 21 ± 135 to 10.65 ± 4.16 ng/100 ml(P<0.01). Clinical improvement remained stable in seven patients for more than six months. In all cases theoptimal dose did not need to be altered because of lachyphylaxis. Side effects were rare because of the lowdoses used (mean = 200 mg). The results suggest that Captopril may be useful in the treatment of congestive heart failure. [ABSTRACT FROM PUBLISHER]

To investigate whether detection of ventricular late potentials could provide prognostic information in patients with congestive heart failure with or without bundle branch block, we prospectively obtained a signal-averaged ECG from 151 patients with congestive heart failure, using specific criteria in 57 patients with bundle branch block. Late potentials were detected in 49 patients (32.5%); their incidence was not significantly different in patients without (31%; 29 patients) or with bundle branch block (35%; 20 patients). Late potentials were present in 25 of 73 patients (34%) with idiopathic dilated cardiomyopathy, in 20 of 57 patients (35%) with ischaemic cardiomyopathy and in four of 21 patients (19%) with hypertensive heart disease (ns). Age, NYHA class, ejection fraction and use of amiodarone were not statistically different among patients with or without late potentials. In contrast, patients with late potentials had more past episodes of sustained ventricular tachycardia (8.2%; four patients) than those without late potentials (1.9%; two patients). Twenty four hour ambulatory ECGs were obtained in 135 patients (89%). Non-sustained ventricular tachycardia was not correlated with the presence of late potentials found in 45 of 88 patients (51%) without late potentials and in 29 of 47 patients (62%) with late potentials (ns). The mean follow-up was 27 +/- 12 months; 51 patients died, 31 from progressive congestive heart failure and 13 suddenly; seven prospectively had sustained ventricular tachycardia. The total mortality rate, the cardiac mortality rate and sudden death risk were not significantly related to the presence of late potentials; their incidence were respectively 35% (36 patients), 32% (33 patients) and 10% (10 patients) in patients without late potentials and 31% (15 patients), 23% (11 patients) and 6% (three patients) in those without late potentials. The incidence of sustained ventricular tachycardia during follow-up was 2% (two patients) in patients without late potentials and 10% (five patients) in those with late potentials. The incidence of sustained ventricular tachycardia experienced by the patients before the study or seen during follow-up was significantly increased in the presence of late potentials: 18% (nine patients) vs 2% (two patients) in the absence of late potentials (P < 0.001). Removal from the study of data from patients with bundle branch block, patients with severe congestive heart failure (NYHA 3 or 4) or patients taking amiodarone did not alter these results. Thus, signal-averaged ECG results only improved risk stratification for sustained ventricular tachycardia in patients with congestive heart failure and failed to identify patients at high risk for sudden death.