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) ≤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). Conclusion — BNP levels are a strong, independent predictor of sudden death in patients with CHF.