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

Abstract

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) Յ35%. 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 (Pϭ0.0006), log N-terminal atrial natriuretic peptide (Pϭ0.003), LVEF (Pϭ0.005), log N-terminal BNP (Pϭ0.006), systolic blood pressure (Pϭ0.01), big endothelin (Pϭ0.03), and NYHA class (Pϭ0.04). In the multivariate model, log BNP level was the only independent predictor of sudden death (Pϭ0.0006). Using a cutoff point of log BNP Ͻ2.11 (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 (Pϭ0.0001). Conclusion-BNP levels are a strong, independent predictor of sudden death in patients with CHF.

N-terminal pro-brain natriuretic peptide and the timing, extent and mortality in ST elevation myocardial infarction

“…Our study extends these prior findings by demonstrating that, at baseline, 24 h and 72 h, NT-proBNP predicts adverse events independent Other studies have demonstrated that BNP predicts adverse events, particularly sudden cardiac death, in both the postmyocardial infarction (19) and heart failure populations (20). One potential clinical application of natriuretic peptides, yet to be tested, is to stratify patients according to their sudden cardiac death risk and to identify, together with other clinical variables, who may benefit from implantation of a cardioverter defibrillator.…”

Inflammatory Biomarkers are not Predictive of Intermediate‐term Risk of Ventricular Tachyarrhythmias in Stable CHF Patients

“…Although increased plasma levels of IL-6, 4 -7 TNF-α, 7,17 CRP 8 -10 and BNP 12,13 are all correlated with increased mortality in patients with chronic HF, the current study revealed that plasma levels of IL-6, TNF-α, CRP or BNP were not predictive of ventricular tachyarrhythmias in patients with moderate to severe systolic LV dysfunction.…”

“…In addition to these biomarkers, brain natriuretic peptide (BNP), released by ventricular cardiomyocytes in response to myocardial tension and increased intravascular volume, was consistently shown to predict poor outcome 6,11 including sudden death 12,13 among HF patients.…”

Role of B‐Type Natriuretic Peptide and N‐Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus

“…B‐type natriuretic peptide (BNP) and N‐terminal prohormone B‐type natriuretic peptide (NT‐proBNP) levels are well established predictors of HF hospitalization and mortality in patients with HF 4, 5, 6, 7. However, as the incidences of outcomes differ between patients with HF8 and patients with a recent ACS9 in a stable phase, it is less established how natriuretic peptides are associated with cardiovascular outcomes, especially subsequent MI and stroke, in the latter population 3, 10, 11, 12, 13, 14.…”