title: B-type natriuretic peptide predicts sudden death in patients with chronic heart failure.
abstract: BACKGROUND
  Given the high incidence of sudden death in patients with chronic heart failure (CHF) and the efficacy of implantable cardioverter-defibrillators, an appropriate tool for the prediction of sudden death is desirable. B-type natriuretic peptide (BNP) has prognostic significance in CHF, and the stimuli for its production cause electrophysiological abnormalities. This study tests BNP levels as a predictor of sudden death.
  
  
  RESULTS
  BNP levels, in addition to other neurohormonal, clinical, and hemodynamic variables, were obtained from 452 patients with a left ventricular ejection fraction (LVEF) < or =35%. For prediction of sudden death, only survivors without heart transplantation (HTx) or a mechanical assist device and patients who died suddenly were analyzed. Up to 3 years, 293 patients survived without HTx or a mechanical assist device, 89 patients died, and 65 patients underwent HTx. Mode of death was sudden in 44 patients (49%), whereas 31 patients (35%) had pump failure and 14 patients (16%) died from other causes. Univariate risk factors of sudden death were log BNP (P=0.0006), log N-terminal atrial natriuretic peptide (P=0.003), LVEF (P=0.005), log N-terminal BNP (P=0.006), systolic blood pressure (P=0.01), big endothelin (P=0.03), and NYHA class (P=0.04). In the multivariate model, log BNP level was the only independent predictor of sudden death (P=0.0006). Using a cutoff point of log BNP <2.11 (130 pg/mL), Kaplan-Meier sudden death-free survival rates were significantly higher in patients below (99%) compared with patients above (81%) this cutoff point (P=0.0001).
  
  
  CONCLUSIONS
  BNP levels are a strong, independent predictor of sudden death in patients with CHF.
authors.affiliation: Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria. rberger@gmx.at
authors.forename: Rudolf
authors.initials: R
authors.lastname: Berger
authors.forename: Martin
authors.initials: M
authors.lastname: Huelsman
authors.forename: Karin
authors.initials: K
authors.lastname: Strecker
authors.forename: Anja
authors.initials: A
authors.lastname: Bojic
authors.forename: Petra
authors.initials: P
authors.lastname: Moser
authors.forename: Brigitte
authors.initials: B
authors.lastname: Stanek
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000527:Alprostadil / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000401:mortality; D009320:Atrial Natriuretic Factor / Q000097:blood*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D019332:Endothelin-1; D016232:Endothelins / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D019332:Endothelin-1; D016232:Endothelins; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D000527:Alprostadil