Nina M. Chinn

Noninvasive Predictors of Sudden Cardiac Death In Men With Coronary Heart Disease Predictive Value of Maximal Stress Testing

In a follow-up study of 1,852 men with coronary heart disease, 195 deaths occurred within the first 3 years (33 +/- 13 months [mean +/- standard deviation]). Analysis of these cases indicated that the risk of sudden cardiac death in ambulatory men with clinical manifestations of coronary heart disease may be readily estimated from noninvasive clinical and exercise criteria. The important predictors are indexes of the severity of coronary heart disease and impairment of peak left ventricular function demonstrated with symptom-limited maximal exercise. The advantages of these predictors are that they may be elicited on the initial study as well as on follow-up noninvasive examinations of ambulatory patients. The appearance of nonelectrocardiographic predictors in serial examinations may provide an indication for invasive studies and be a more important finding than the ischemic S-T reponse to exertion.

The sudden infant death syndrome: repetitions in families.

REPORTS on repetition of s~udden infant death syndrome in families have, for th~ most part, been anecdotal? Available information, therefore, is insufficient for either counseling parents or for addressing questions about heritability. In the United States the incidence rate of SIDS ranges between two and three per 1,000 live births per year. The incidence rate of repetitions would necessarily be some fraction of the total. To study events which occur this seldom would require a population based investigation on an immense scale. We elected, therefore, to conduct a study which would permit an estimation of the risk of repetition of SIDS among subsequently born children of families who had experienced at least one episode. To accomplish this objective we sought assistance from officers and staff members of the National Sudden Infant Death Syndrome Foundation and the Guild for Infant Survival, as well as from representatives of Regional SIDS Centers, who informed SIDS parents within their purview about the project and distributed questionnaires to those who wished to participate. Parents sent completed questionnaires directly to the project office at the University of Washington. This data collection scheme, which was dictated by necessity, precluded estimation of a response rate. However, representativeness of the subjects with respect to familial aggregations, with overestimation a major consideration, constitutes a more relevant concern than the sample fraction per se. Despite the obvious limitations of this avenue of investigation, Similar studies have helped to assess familial aggregation in a variety of diseases. We could not conceive of a practical alternative to this approach that would yield a sufficient number of families with systematically collected information concernmg each family member. The nationwide solicitation of SIDS parents for information, initiated in April, 1976, has now produced sufficient data to warrant analysis.