Bayes-Genis Antoni, Vazquez Rafael, Puig Teresa, Fernandez-Palomeque Carlos, Fabregat Jordi, Bardají Alfredo, Pascual-Figal Domingo, Ordoñez-Llanos Jordi, Valdes Mariano, Gabarrús Albert, Pavon Ricardo, Pastor Luis, Gonzalez Juanatey Jose Ramon, Almendral Jesus, Fiol Miquel, Nieto Vicente, Macaya Carlos, Cinca Juan, Bayes de Luna Antoni
Cardiology Service, Hospital Santa Creu i Sant Pau-ICCC, Barcelona, and Hospital Universitario, Santiago de Compostela, Spain.
Eur J Heart Fail. 2007 Aug;9(8):802-7. doi: 10.1016/j.ejheart.2007.05.001. Epub 2007 Jun 13.
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.
A cohort of 494 patients with established HF had baseline echocardiographic and NT-proBNP measurements and were followed for 942+/-323 days.
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<or=26 mm/m2 and NT-proBNP<or=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).
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.
在已确诊心力衰竭（HF）的患者中识别心脏性猝死（SCD）的有价值标志物仍然是一项挑战。我们试图评估临床、超声心动图和生化变量在预测因收缩功能障碍导致心力衰竭（HF）的连续队列患者发生SCD中的价值。
对494例已确诊HF的患者进行了基线超声心动图和NT - proBNP测量，并随访942±323天。
50例患者发生SCD。SCD的独立预测因素为左房内径指数>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）、心肌梗死病史（HR 2.3；95%CI 1.3 - 4.1；p = 0.007）、外周水肿（HR 2.1；95%CI 1.1 - 3.9；p = 0.02）和糖尿病（HR 1.9；95%CI 1.1 - 3.3；p = 0.03）。纽约心脏协会（NYHA）心功能分级、左心室射血分数和肾小球滤过率在该队列中不是SCD的独立预测因素。值得注意的是，左房内径指数>26 mm/m2和NT - proBNP>908 ng/L同时存在会增加SCD风险（HR 4.3；95%CI 2.5 - 7.6；p<0.0001）。在36个月时，左房内径指数≤26 mm/m2且NT - proBNP≤908 ng/L的患者发生SCD的风险为3%，而左房内径指数>26 mm/m2且NT - proBNP>908 ng/L的患者发生SCD的风险达到25%（p<0.0001）。
在HF患者中，左房内径指数和NT - proBNP水平比其他临床、超声心动图或生化变量更有助于对SCD风险进行分层。在预测HF患者发生SCD时应考虑这两个参数的联合应用。
