B-type natriuretic peptide predicts sudden death in patients with chronic heart failure.
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.
Berger
Rudolf
R
Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria. rberger@gmx.at
Huelsman
Martin
M
Strecker
Karin
K
Bojic
Anja
A
Moser
Petra
P
Stanek
Brigitte
B
Pacher
Richard
R
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
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