on April 29, 2002
Circulation. 2002
Published online before print April 29, 2002, doi: 10.1161/01.CIR.0000016642.15031.34
Published online before print April 29, 2002, doi: 10.1161/01.CIR.0000016642.15031.34
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Submitted on November 27, 2001
From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria. * To whom correspondence should be addressed. E-mail: rberger{at}gmx.at.
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. Methods and Results—BNP levels, in addition to other neurohormonal, clinical, and hemodynamic variables, were obtained from 452 patients with a left ventricular ejection fraction (LVEF) Conclusion—BNP levels are a strong, independent predictor of sudden death in patients with CHF.
Revised on March 10, 2002
Accepted on March 13, 2002
B-Type Natriuretic Peptide Predicts
Sudden Death in Patients With Chronic Heart Failure
Rudolf Berger MD*,
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).
Key words: heart failure • death, sudden • prognosis • natriuretic peptides
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H. Ohuchi, H. Takasugi, H. Ohashi, O. Yamada, K. Watanabe, T. Yagihara, and S. Echigo Abnormalities of Neurohormonal and Cardiac Autonomic Nervous Activities Relate Poorly to Functional Status in Fontan Patients Circulation, October 26, 2004; 110(17): 2601 - 2608. [Abstract] [Full Text] [PDF]
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T. Jernberg, S. James, B. Lindahl, N. Johnston, M. Stridsberg, P. Venge, and L. Wallentin Natriuretic peptides in unstable coronary artery disease Eur. Heart J., September 1, 2004; 25(17): 1486 - 1493. [Abstract] [Full Text] [PDF]
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S. Z. Pantilat and A. E. Steimle Palliative Care for Patients With Heart Failure JAMA, May 26, 2004; 291(20): 2476 - 2482. [Abstract] [Full Text] [PDF]
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S. de Denus, C. Pharand, and D. R. Williamson Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone Chest, February 1, 2004; 125(2): 652 - 668. [Abstract] [Full Text] [PDF]
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