B-Type Natriuretic Peptide Predicts Sudden Death in Patients With Chronic Heart Failure

DOI Web Site 被引用文献28件
  • Rudolf Berger
    From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.
  • Martin Huelsman
    From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.
  • Karin Strecker
    From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.
  • Anja Bojic
    From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.
  • Petra Moser
    From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.
  • Brigitte Stanek
    From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.
  • Richard Pacher
    From the Department of Cardiology, Ludwig Boltzman Institute of Experimental Endocrinology and Ludwig Boltzman Institute of Cardiovascular Research, University of Vienna, Austria.

抄録

<jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Background</jats:italic> </jats:bold> — </jats:italic> </jats:bold> 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. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Methods and Results</jats:italic> </jats:bold> — </jats:italic> </jats:bold> 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 ( <jats:italic>P</jats:italic> =0.0006), log N-terminal atrial natriuretic peptide ( <jats:italic>P</jats:italic> =0.003), LVEF ( <jats:italic>P</jats:italic> =0.005), log N-terminal BNP ( <jats:italic>P</jats:italic> =0.006), systolic blood pressure ( <jats:italic>P</jats:italic> =0.01), big endothelin ( <jats:italic>P</jats:italic> =0.03), and NYHA class ( <jats:italic>P</jats:italic> =0.04). In the multivariate model, log BNP level was the only independent predictor of sudden death ( <jats:italic>P</jats:italic> =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 ( <jats:italic>P</jats:italic> =0.0001). </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Conclusion</jats:italic> </jats:bold> — </jats:italic> </jats:bold> BNP levels are a strong, independent predictor of sudden death in patients with CHF. </jats:p>

収録刊行物

  • Circulation

    Circulation 105 (20), 2392-2397, 2002-05-21

    Ovid Technologies (Wolters Kluwer Health)

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