Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure.
OBJECTIVE
The identification of valuable markers of sudden cardiac death (SCD) in patients with established HF remains a challenge. We sought to assess the value of clinical, echocardiographic and biochemical variables to predict SCD in a consecutive cohort of patients with heart failure (HF) due to systolic dysfunction.


METHODS
A cohort of 494 patients with established HF had baseline echocardiographic and NT-proBNP measurements and were followed for 942+/-323 days.


RESULTS
Fifty patients suffered SCD. Independent predictors of SCD were indexed LA size>26 mm/m2 (HR 2.8; 95% CI 1.5-5.0; p=0.0007), NT-proBNP>908 ng/L (HR 3.1; 95% CI 1.5-6.7; p=0.003), history of myocardial infarction (HR 2.3; 95% CI 1.3-4.1; p=0.007), peripheral oedema (HR 2.1; 95% CI 1.1-3.9; p=0.02), and diabetes mellitus (HR 1.9; 95% CI 1.1-3.3; p=0.03). NYHA functional class, left ventricular ejection fraction and glomerular filtration rate were not independent predictors of SCD in this cohort. Notably, the combination of both LA size>26 mm/m2 and NT-proBNP>908 ng/L increased the risk of SCD (HR 4.3; 95% CI 2.5-7.6; p<0.0001). At 36 months, risk of SCD in patients with indexed LA size<or=26 mm/m2 and NT-proBNP<or=908 ng/L was 3%, while in patients with indexed LA size>26 mm/m2 and NT-proBNP>908 ng/L reached 25% (p<0.0001).


CONCLUSIONS
Among HF patients, indexed LA size and NT-proBNP levels are more useful to stratify risk of SCD than other clinical, echocardiographic or biochemical variables. The combination of these two parameters should be considered for predicting SCD in patients with HF.
Bayes-Genis
Antoni
A
Cardiology Service, Hospital Santa Creu i Sant Pau-ICCC, Barcelona, and Hospital Universitario, Santiago de Compostela, Spain. abayesgenis@santpau.es
Vazquez
Rafael
R
Puig
Teresa
T
Fernandez-Palomeque
Carlos
C
Fabregat
Jordi
J
Bardají
Alfredo
A
Pascual-Figal
Domingo
D
Ordoñez-Llanos
Jordi
J
Valdes
Mariano
M
Gabarrús
Albert
A
Pavon
Ricardo
R
Pastor
Luis
L
Gonzalez Juanatey
Jose Ramon
JR
Almendral
Jesus
J
Fiol
Miquel
M
Nieto
Vicente
V
Macaya
Carlos
C
Cinca
Juan
J
Bayes de Luna
Antoni
A
D000368:Aged; D006332:Cardiomegaly / Q000097:blood / Q000453:epidemiology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006325:Heart Atria; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain