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Neurohormonal risk stratification for sudden death and death owing to progressive heart failure in chronic heart failure.
Eur J Clin Invest. 2005 Jan; 35(1):24-31.EJ

Abstract

BACKGROUND

This study tested various neurohormones for prediction of heart failure death (death owing to progressive deterioration of ventricular function; HFD). Moreover, B-type natriuretic peptide (BNP) as a predictor of sudden death (SD; as reported previously) and the best predictor of HFD were combined for a simple risk stratification model.

DESIGN

BNP, the N-terminal fragment of BNP (N-BNP), and of the atrial natriuretic peptide (N-ANP) and big endothelin levels were obtained from 452 patients with a left ventricular ejection fraction </= 35%. Outcome was documented during an observation period up to 3 years.

RESULTS

Two hundred and ninety-eight patients survived without heart transplantation, 65 patients underwent heart transplantation and 89 patients died (SD 44 patients, HFD 31 patients, other causes 14 patients). The only independent predictor of SD was BNP (as reported), and the best independent predictor of HFD was N-ANP (P = 0.0001). Analyzing 293 survivors and 44 patients with SD, fewer patients with BNP < 130 pg mL(-1) (Group A, n = 110) died [1%] as compared with patients with BNP > 130 pg mL(-1) and N-ANP < 6300 fmol mL(-1) (Group B, n = 177; 18%; P = 0.0001) and patients with BNP > 130 pg mL(-1) and N-ANP > 6300 fmol mL(-1) (Group C, n = 50; 19%; P = 0.0001). Analyzing 293 survivors and 31 patients with HFD, fewer patients died in Group A (n = 109; 0%; P = 0.0001) and Group B (n = 153; 6%; P = 0.0001) as compared with patients of Group C (n = 62; 34%).

CONCLUSION

Prognostic power of neurohormones depends on the mode of death. The combined determination of BNP and N-ANP identifies patients with minimal risk of death, elevated SD but low HFD risk as well as elevated SD and HFD risk.

Authors+Show Affiliations

University of Vienna, Vienna, Austria. rberger@gmx.atNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15638816

Citation

Berger, R, et al. "Neurohormonal Risk Stratification for Sudden Death and Death Owing to Progressive Heart Failure in Chronic Heart Failure." European Journal of Clinical Investigation, vol. 35, no. 1, 2005, pp. 24-31.
Berger R, Huelsmann M, Strecker K, et al. Neurohormonal risk stratification for sudden death and death owing to progressive heart failure in chronic heart failure. Eur J Clin Invest. 2005;35(1):24-31.
Berger, R., Huelsmann, M., Strecker, K., Moertl, D., Moser, P., Bojic, A., & Pacher, R. (2005). Neurohormonal risk stratification for sudden death and death owing to progressive heart failure in chronic heart failure. European Journal of Clinical Investigation, 35(1), 24-31.
Berger R, et al. Neurohormonal Risk Stratification for Sudden Death and Death Owing to Progressive Heart Failure in Chronic Heart Failure. Eur J Clin Invest. 2005;35(1):24-31. PubMed PMID: 15638816.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurohormonal risk stratification for sudden death and death owing to progressive heart failure in chronic heart failure. AU - Berger,R, AU - Huelsmann,M, AU - Strecker,K, AU - Moertl,D, AU - Moser,P, AU - Bojic,A, AU - Pacher,R, PY - 2005/1/11/pubmed PY - 2005/4/13/medline PY - 2005/1/11/entrez SP - 24 EP - 31 JF - European journal of clinical investigation JO - Eur J Clin Invest VL - 35 IS - 1 N2 - BACKGROUND: This study tested various neurohormones for prediction of heart failure death (death owing to progressive deterioration of ventricular function; HFD). Moreover, B-type natriuretic peptide (BNP) as a predictor of sudden death (SD; as reported previously) and the best predictor of HFD were combined for a simple risk stratification model. DESIGN: BNP, the N-terminal fragment of BNP (N-BNP), and of the atrial natriuretic peptide (N-ANP) and big endothelin levels were obtained from 452 patients with a left ventricular ejection fraction </= 35%. Outcome was documented during an observation period up to 3 years. RESULTS: Two hundred and ninety-eight patients survived without heart transplantation, 65 patients underwent heart transplantation and 89 patients died (SD 44 patients, HFD 31 patients, other causes 14 patients). The only independent predictor of SD was BNP (as reported), and the best independent predictor of HFD was N-ANP (P = 0.0001). Analyzing 293 survivors and 44 patients with SD, fewer patients with BNP < 130 pg mL(-1) (Group A, n = 110) died [1%] as compared with patients with BNP > 130 pg mL(-1) and N-ANP < 6300 fmol mL(-1) (Group B, n = 177; 18%; P = 0.0001) and patients with BNP > 130 pg mL(-1) and N-ANP > 6300 fmol mL(-1) (Group C, n = 50; 19%; P = 0.0001). Analyzing 293 survivors and 31 patients with HFD, fewer patients died in Group A (n = 109; 0%; P = 0.0001) and Group B (n = 153; 6%; P = 0.0001) as compared with patients of Group C (n = 62; 34%). CONCLUSION: Prognostic power of neurohormones depends on the mode of death. The combined determination of BNP and N-ANP identifies patients with minimal risk of death, elevated SD but low HFD risk as well as elevated SD and HFD risk. SN - 0014-2972 UR - https://www.unboundmedicine.com/medline/citation/15638816/Neurohormonal_risk_stratification_for_sudden_death_and_death_owing_to_progressive_heart_failure_in_chronic_heart_failure_ L2 - https://doi.org/10.1111/j.1365-2362.2005.01442.x DB - PRIME DP - Unbound Medicine ER -