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European Journal of Heart Failure 2006 8(3):237-242; doi:10.1016/j.ejheart.2005.08.003
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© 2005 European Society of Cardiology

Accumulation of risk markers predicts the incidence of sudden death in patients with chronic heart failure

Jun Watanabe*, Tsuyoshi Shinozaki, Nobuyuki Shiba, Kohei Fukahori, Yoshito Koseki, Akihiko Karibe, Masahito Sakuma, Masahito Miura, Yutaka Kagaya and Kunio Shirato

Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

* Corresponding author. Tel.: +81 22 717 715; fax: +81 22 717 7156. E-mail address: watanabe{at}cardio.med.tohoku.ac.jp


  Abstract

Background: Sudden death is common in chronic heart failure (CHF). Risk stratification is the first step for primary prevention.

Aim: To evaluate the use of risk markers for estimating sudden death risk.

Methods and results: We prospectively examined 680 stable patients with CHF. Risk markers were evaluated using the Cox's proportional hazard model in a stepwise manner. Ejection fraction <30%, left ventricular end-diastolic diameter >60 mm, brain natriuretic peptide >200 pg/ml, non-sustained ventricular tachycardia, and diabetes were significantly associated with increased risk of sudden death. When the number of risk markers were included as co-variables, only "number of risk markers ≥3" entered the model (hazard ratio 8.95, 95% confidence interval 4.57–17.52), while the effects of individual markers did not enter the model. The annual mortality from sudden death was 11% in patients with 3 or more risk markers and 1.4% in patients with 2 or less.

Conclusions: Rather than particular risk markers, the number of accumulated risk markers was a more powerful predictor for sudden death in patients with CHF. The number of risk markers could be useful for risk stratification of sudden death.

Key Words: Brain natriuretic peptide • Ejection fraction • Observational study • Risk markers • Heart failure

Received February 19, 2005; Revised June 21, 2005; Accepted August 22, 2005


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