Sudden Death May Show a Circadian Time of Risk Depending on Its Anatomo-clinical Causes and Age

Abstract

The aim of this study was to determine whether the time of occurrence of sudden death exhibits a circadian rhythm depending on its different anatomoclinical causes. A longitudinal prospective investigation of 610 nonhospitalized subjects who died suddenly in the Emergency Room of Ferrara Hospital between January 1983 and December 1990 was conducted. All subjects underwent autopsy. Sudden death was classified on the basis of the following pathological causes; acute myocardial infarction, acute myocardial failure, intracerebral hemorrhage, rupture of aortic aneurysm, pulmonary embolism, and clinical causes, i.e., arrhythmia and circulatory failure. The investigated cases were stratified into 2 groups according to age; Group A=age <70 years (n=301, 49.3%), and Group B=age =70 (n=309, 51.7%). The assessment of circadian rhythmicity was performed utilizing the single cosinor method. The results by cosinor analysis found a circadian rhythmicity for cases of sudden death (peak at 14.04, n=610, p=0.036), and in particular for females (peak at 13.12, n=200, p=0.004). Spectral analysis detected a statistical ultradian cycle in males having an 8-hour period (p=0.015). A statistically significant circadian rhythm was found for cases of sudden death due to acute myocardial infarction (peak at 15.28, n=330, p=0.013), pulmonary embolism (peak at 11.46, n=56, p=0.003) and arrhythmia (peak at 13.08, n=291, p=0.04). In Group A no significant circadian rhythm was found, whereas in Group B a significant rhythmicity was found for sudden death from cardiac causes at 13.32 (n=249, p=0.015), from myocardial infarction at 15.02 (n=154, p=0.018) and from arrhythmia at 13.07 (n=122, p=0.014). Different circadian patterns of onset of sudden death may be shown in various subgroups of patients, due not only to different pathophysiologic mechanisms but also to anatomo-clinical aspects. (Jpn Heart J 34: 729-739, 1993). © 1993, International Heart Journal Association. All rights reserved.