© 2007 European Society of Cardiology
Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure
a Cardiology Service, Hospital Santa Creu i Sant Pau-ICCC Barcelona, Spain
b Cardiology Service, Hospital de Valme Seville, Spain
c Epidemiology Service, Hospital Santa Creu i Sant Pau Barcelona, Spain
d Cardiology Service, Hospital Son Dureta Palma de Mallorca, Spain
e Cardiology Service, Hospital Joan XXIII Tarragona, Spain
f Cardiology Service, Hospital Virgen Arrixaca Murcia, Spain
g Biochemistry Service, Hospital Santa Creu i Sant Pau Barcelona, Spain
h Cardiology Service, Hospital Universitario Santiago de Compostela Spain
i Cardiology Service, Hospital Gregorio Marañon Madrid, Spain
j Cardiology Service, Hospital Insular, Las Palmas de Gran Canaria Spain
k Cardiology Service, Hospital Clínico Madrid, Spain
* Corresponding author. Servei de Cardiologia-ICCC, Hospital Santa Creu i Sant Pau, Departament de Medicina, Universitat Autònoma de Barcelona, St. Antoni Ma. Claret 167, 08025 Barcelona, Spain. E-mail address: abayesgenis{at}santpau.es
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Abstract |
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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/m2 (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/m2 and NT-proBNP 908 ng/L was 3%, while in patients with indexed LA size >26 mm/m2 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.
Key Words: Left atrial enlargement • NT-proBNP • Sudden cardiac death
Received November 22, 2006; Revised March 5, 2007; Accepted May 1, 2007
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