title: Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure.
abstract: 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.
authors.affiliation: Cardiology Service, Hospital Santa Creu i Sant Pau-ICCC, Barcelona, and Hospital Universitario, Santiago de Compostela, Spain. abayesgenis@santpau.es
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
authors.forename: Rafael
authors.initials: R
authors.lastname: Vazquez
authors.forename: Teresa
authors.initials: T
authors.lastname: Puig
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez-Palomeque
authors.forename: Jordi
authors.initials: J
authors.lastname: Fabregat
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bardají
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordoñez-Llanos
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdes
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrús
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pavon
authors.forename: Luis
authors.initials: L
authors.lastname: Pastor
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Gonzalez Juanatey
authors.forename: Jesus
authors.initials: J
authors.lastname: Almendral
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: Vicente
authors.initials: V
authors.lastname: Nieto
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes de Luna
mesh_terms: 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
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain