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(Circulation. 2002;105:2392.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.
Correspondence to Rudolf Berger, MD, University of Vienna, Department of Cardiology, Waehringer Guertel 18-20, A-1090 Vienna, Austria. 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)
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 deathfree survival rates were significantly higher in patients below (99%) compared with patients above (81%) this cutoff point (P=0.0001).
Conclusion BNP levels are a strong, independent predictor of sudden death in patients with CHF.
Key Words: heart failure death, sudden prognosis natriuretic peptides
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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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R. J. Rodeheffer Measuring plasma B-type natriuretic peptide in heart failure: Good to go in 2004? J. Am. Coll. Cardiol., August 18, 2004; 44(4): 740 - 749. [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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J. Bergler-Klein, U. Klaar, M. Heger, R. Rosenhek, G. Mundigler, H. Gabriel, T. Binder, R. Pacher, G. Maurer, and H. Baumgartner Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis Circulation, May 18, 2004; 109(19): 2302 - 2308. [Abstract] [Full Text] [PDF] |
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R. J DiDomenico, H. Y Park, M. R. Southworth, H. M Eyrich, R. K Lewis, J. M Finley, and G. T Schumock Guidelines for Acute Decompensated Heart Failure Treatment Ann. Pharmacother., April 1, 2004; 38(4): 649 - 660. [Abstract] [Full Text] [PDF] |
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P. Bettencourt NT-proBNP and BNP: biomarkers for heart failure management Eur J Heart Fail, March 15, 2004; 6(3): 359 - 363. [Abstract] [Full Text] [PDF] |
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J. M. Tapanainen, K. S. Lindgren, T. H. Makikallio, O. Vuolteenaho, J. Leppaluoto, and H. V. Huikuri Natriuretic peptides as predictors of non-sudden and sudden cardiac death after acute myocardial infarction in the beta-blocking era J. Am. Coll. Cardiol., March 3, 2004; 43(5): 757 - 763. [Abstract] [Full Text] [PDF] |
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J H McGowan Hibernating myocardium: high or low risk? Heart, March 1, 2004; 90(3): 237 - 238. [Full Text] [PDF] |
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D. Logeart, G. Thabut, P. Jourdain, C. Chavelas, P. Beyne, F. Beauvais, E. Bouvier, and A. C. Solal Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure J. Am. Coll. Cardiol., February 18, 2004; 43(4): 635 - 641. [Abstract] [Full Text] [PDF] |
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T. J. Wang, M. G. Larson, D. Levy, E. J. Benjamin, E. P. Leip, T. Omland, P. A. Wolf, and R. S. Vasan Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death N. Engl. J. Med., February 12, 2004; 350(7): 655 - 663. [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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M. Kyuma, T. Nakata, A. Hashimoto, K. Nagao, H. Sasao, T. Takahashi, K. Tsuchihashi, and K. Shimamoto Incremental Prognostic Implications of Brain Natriuretic Peptide, Cardiac Sympathetic Nerve Innervation, and Noncardiac Disorders in Patients with Heart Failure J. Nucl. Med., February 1, 2004; 45(2): 155 - 163. [Abstract] [Full Text] [PDF] |
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A. Prahash and T. Lynch B-Type Natriuretic Peptide: A Diagnostic, Prognostic, and Therapeutic Tool in Heart Failure Am. J. Crit. Care., January 1, 2004; 13(1): 46 - 53. [Abstract] [Full Text] [PDF] |
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E. C. Vourvouri, A. F.L. Schinkel, J. R.T.C. Roelandt, F. Boomsma, G. Sianos, M. Bountioukos, F. B. Sozzi, V. Rizzello, J. J. Bax, H. I. Karvounis, et al. Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device Eur J Heart Fail, December 1, 2003; 5(6): 767 - 774. [Abstract] [Full Text] [PDF] |
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