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Left atrial enlargement and NT‐proBNP as predictors of sudden cardiac death in patients with heart failure
Author(s) -
BayesGenis Antoni,
Vazquez Rafael,
Puig Teresa,
FernandezPalomeque Carlos,
Fabregat Jordi,
Bardají Alfredo,
PascualFigal Domingo,
OrdoñezLlanos Jordi,
Valdes Mariano,
Gabarrús Albert,
Pavon Ricardo,
Pastor Luis,
Juanatey Jose Ramon Gonzalez,
Almendral Jesus,
Fiol Miquel,
Nieto Vicente,
Macaya Carlos,
Cinca Juan,
Luna Antoni Bayes
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2007.05.001
Subject(s) - medicine , heart failure , cardiology , ejection fraction , cohort , myocardial infarction , left atrial enlargement , diabetes mellitus , sudden cardiac death , atrial fibrillation , endocrinology , sinus rhythm
Aims 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/m 2 (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 ≤26 mm/m 2 and NT‐proBNP ≤908 ng/L was 3%, while in patients with indexed LA size >26 mm/m 2 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.