Brain natriuretic peptide for the prediction of sudden cardiac death and ventricular arrhythmias: a meta-analysis
1 Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK
2 University of Southampton, Southampton, UK
* Corresponding author. Tel: +44 2380 798487, Fax: +44 2380 796614, Email: paul.andrew.scott{at}btinternet.com
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Abstract |
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Aims: The risk stratification of patients for sudden cardiac death (SCD) remains a challenge. Brain natriuretic peptide (BNP) predicts overall mortality in heart disease but it is unclear how well it predicts SCD. We therefore performed a meta-analysis of studies evaluating the accuracy of BNP to predict SCD and ventricular arrhythmias (VA).
Methods and results: Electronic databases and published bibliographies were systematically searched (1984–2008). We found 14 studies that met our inclusion criteria. Six studies (3543 patients) evaluated BNP to predict SCD in patients without implantable cardioverter defibrillators (ICDs) across a wide range of populations. A raised BNP predicted SCD with a relative risk of 3.68 [95% confidence interval (CI) 1.90, 7.14]. Eight studies (1047 patients) evaluated BNP to predict the occurrence of VA in patients with ICDs. A raised BNP predicted the occurrence of VA with a relative risk of 2.54 (95% CI 1.87, 3.44).
Conclusion: The measurement of BNP has significant value in predicting SCD and VA. However, the benefit of BNP testing in addition to other risk stratification tests is unclear and BNP needs to be evaluated prospectively in combination with other complementary risk stratification tools.
Key Words: Brain natriuretic peptide • Sudden death • Ventricular arrhythmias • Meta-analysis
Received April 9, 2009; Revised July 25, 2009; Accepted August 7, 2009