The value of N-terminal pro-B-type natriuretic peptide (NT Pro-BNP) to predict sudden cardiac death in chronic heart failure patients with normal renal function; a systematic review and meta-analysis

Context: The role of N-terminal pro-B-type natriuretic peptide (NT pro-BNP) has been understood as an important and critical biomarker in the diagnosis and predicting poor outcome of cardiac dysfunction. Objectives: We aimed to systematically review the papers on the value of NT pro-BNP in prediction of sudden cardiac death (SCD) in chronic heart failure (CHF) patients. Data Sources: This study was based on the Systematic Reviews and Meta-analysis (PRISMA) study reporting system. Study Selection: During the deep searches using the keywords, 67 studies were initially considered for primary assessment. Of those, 12 were completely matched with the study endpoint. In final, six were excluded because of unavailability of full texts or acquired data and thus six studies were finally analyzed. Data Extraction: Two researchers independently used the key words "chronic heart failure, B-type natriuretic peptide, sudden cardiac death" and their combination and searched the national and international databases including Scopus, PubMed, Science Direct, Web of Science, Springer, and the Google Scholar search engine. Results: The pooled prevalence of SCD in CHF patients was found to be 6.9% (95% CI: 5.2% to 9.0%). The statistical heterogeneity was high with an I2 of 84.488. Abnormal elevated level of NT pro-BNP was significantly associated with the increased risk for SCD with a hazard ratio of 4.2 (95% CI: 2.2 to 8.7). Conclusion: Measuring the serum level of NT pro-BNP in CHF patients can be valuable to predict long-term SCD. In this regard, significant elevation of this biomarker may be associated with the four-fold risk of SCD in such patients.

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Common RyR2 variants associate with ventricular arrhythmias and sudden cardiac death in chronic heart failure

Clinical Science ◽

10.1042/cs20090656 ◽

2010 ◽

Vol 119 (5) ◽

pp. 215-226 ◽

Cited By ~ 19

Author(s):

Yuqin Ran ◽

Jingzhou Chen ◽

Ning Li ◽

Weili Zhang ◽

Li Feng ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Protective Factor ◽

Critical Role ◽

Functional Variants ◽

Increased Risk ◽

Genes Encoding

Ca2+ cycling plays a critical role in heart failure and lethal arrhythmias. As susceptibility to sudden cardiac death is considered to be a heritable trait in general population, we have therefore investigated whether potentially functional variants of genes encoding RyR2 (ryanodine receptor 2) and the L-type Ca2+ channel are related to the risk of ventricular arrhythmias and sudden cardiac death in CHF (chronic heart failure) in a case-control study. We found that the A allele of rs3766871 in RYR2 was associated with an increased risk of ventricular arrhythmias in patients with CHF {odds ratio, 1.66 [95% CI (confidence interval), 1.21–2.26]; P=0.002}. During a median follow-up period of 32 months in 1058 (85.0%) patients, 296 (28.0%) patients died from heart failure, of whom 141 (47.6%) had sudden cardiac death. After adjustment for age, gender and suspected risk factors, patients carrying the A allele of rs3766871 had an increased risk of cardiac death {HR (hazard ratio), 1.53 [95% CI, 1.11–2.12]; P=0.010} and sudden cardiac death [HR, 1.92 (95% CI, 1.25–2.94); P=0.003]. Patients carrying the A allele of rs790896 in RYR2 had a reduced risk of sudden cardiac death [HR, 0.65 (95% CI, 0.45–0.92); P=0.015]. In conclusion, the A allele of rs3766871 in RYR2 not only associates with ventricular arrhythmias, but also serves as an independent predictor of sudden cardiac death, and the A allele of rs790896 in RYR2 is a protective factor against sudden cardiac death in patients with CHF.

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Possibilities of modern biomarkers for assessing the risk of developing ventricular tachyarrhythmias and sudden cardiac death in patients with chronic heart failure

Kardiologiia ◽

10.18087/cardio.2020.4.n487 ◽

2020 ◽

Vol 60 (4) ◽

pp. 101-108

Author(s):

A. Zh. Gasparyan ◽

N. B. Shlevkov ◽

A. A. Skvortsov

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Cardiac Death ◽

Ventricular Tachyarrhythmias ◽

Galectin 3 ◽

Life Threatening

Current biomarkers allow diagnosing a wide array of pathological processes and evaluating effects of therapies and prognosis for cardiological patients. This review focuses on a possibility of using N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble suppressor of tumorigenicity 2 (sST2), galectin-3, and other biomarkers in patients with chronic heart failure for evaluating the risk of life-threatening ventricular tachyarrhythmias and sudden cardiac death.

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Abstract 12925: Combination of Cardiac I-123 Metaiodobenzylguanidine Imaging Findings and Early Repolarization Pattern Improve the Predictive Power of Sudden Cardiac Death in Patients With Chronic Heart Failure

Circulation ◽

10.1161/circ.130.suppl_2.12925 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Atsushi Kikuchi ◽

Takahisa Yamada ◽

Takashi Morita ◽

Yoshio Furukawa ◽

Shunsuke Tamaki ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Cardiac Death ◽

Hazard Ratio ◽

Mibg Imaging ◽

Imaging Findings ◽

Prognostic Information ◽

Early Repolarization ◽

Increased Risk

Background: Identification of patients with chronic heart failure (CHF) at risk for sudden cardiac death (SCD) is an important objective. Cardiac I-123 metaiodobenzylguanidine (MIBG) imaging findings provide prognostic information in patients with CHF. On the other hand, early repolarization pattern (ERP) is associated with life-threatening arrhythmia events. Moreover, it has been shown that ERP would be associated with an increased risk of SCD in CHF patients. However, there is no information available on the long-term prognostic value of combining cardiac MIBG imaging findings and ERP for the prediction of SCD in CHF patients. Methods: We studied 92 CHF outpatients (NYHA class: 2.1±0.6) with LVEF < 40% [30±7%) in our prospective cohort study. We performed MIBG scintigraphy, and measured the heart-to-mediastinum ratio on the delayed image (HMRd), of which the abnormal value was defined as < 1.7. Furthermore, we obtained the standard 12-lead electrocardiogram at enrollment. ERP was defined as J-point elevation ≤ 0.1 mV in at least 2 inferior or lateral leads. Results: At enrollment, 41 patients had abnormal HMRd and 19 patients had ERP. During a follow-up period of 7.7±4.3 yrs, 22 patients died suddenly. A multivariate Cox analysis revealed that HMRd (p=0.001) and ERP (p=0.017) were significantly and independently associated with SCD. Kaplan-Meier analysis showed that SCD was significantly more frequently observed in patients with both abnormal HMRd and ERP and those with either abnormal HMRd or ERP than those with neither abnormal HMRd nor ERP (55% vs 33% vs 7%, respectively, p<0.0001). The hazard ratio for SCD prediction in patients with both abnormal HMRd and ERP was 14.7 (95%CI 3.6 to 60.1), which was twofold of the hazard ratio in patients with either abnormal HMRd or ERP (HR 6.5 [95%CI 1.8 to 7.8]) Conclusion: The combination of cardiac MIBG imaging and ERP would provide the incremental prognostic information for the prediction of SCD in CHF patients.

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Faculty Opinions recommendation of Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726155351.793515453 ◽

2016 ◽

Author(s):

Luis Ruilope ◽

Enrique Morales

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Systematic Review ◽

Sudden Cardiac Death ◽

Randomized Controlled Trials ◽

Cardiac Death ◽

Meta Analysis ◽

Controlled Trials ◽

Aldosterone Antagonists ◽

Randomized Controlled

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Prediction of sudden cardiac death in chronic heart failure patients with reduced ejection fraction by ADMIRE-HF risk score and early repolarization pattern

Journal of Nuclear Cardiology ◽

10.1007/s12350-019-01639-6 ◽

2019 ◽

Vol 27 (3) ◽

pp. 992-1001 ◽

Cited By ~ 2

Author(s):

Iyo Ikeda-Yorifuji ◽

Takahisa Yamada ◽

Shunsuke Tamaki ◽

Takashi Morita ◽

Yoshio Furukawa ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Risk Score ◽

Cardiac Death ◽

Early Repolarization ◽

Reduced Ejection Fraction ◽

Heart Failure Patients

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N-terminal pro-brain natriuretic peptide and sudden cardiac death in hypertrophic cardiomyopathy

Heart ◽

10.1136/heartjnl-2020-317701 ◽

2020 ◽

pp. heartjnl-2020-317701

Author(s):

Guixin Wu ◽

Jie Liu ◽

Shuiyun Wang ◽

Shiqin Yu ◽

Ce Zhang ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Sudden Cardiac Death ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Cardiac Death ◽

Cardiac Fibrosis ◽

Discrimination Performance ◽

Net Reclassification Improvement ◽

C Statistic ◽

Increased Risk

ObjectiveElevated levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with heart failure-related death in hypertrophic cardiomyopathy (HCM), but the relationship between NT-proBNP level and sudden cardiac death (SCD) in HCM remains undefined.MethodsThe study prospectively enrolled 977 unrelated patients with HCM with available NT-proBNP results who were prospectively enrolled and followed for 3.0±2.1 years. The Harrell’s C-statistic under the receiver operating characteristic curve was calculated to evaluate discrimination performance. A combination model was constructed by adding NT-proBNP tertiles to the HCM Risk-SCD model. The correlation between log NT-proBNP level and cardiac fibrosis as measured by late gadolinium enhancement (LGE) or Masson’s staining was analysed.ResultsDuring follow-up, 29 patients had SCD. Increased log NT-proBNP levels were associated with an increased risk of SCD events (adjusted HR 22.27, 95% CI 10.93 to 65.63, p<0.001). The C-statistic of NT-proBNP in predicting SCD events was 0.80 (p<0.001). The combined model significantly improved the predictive efficiency of the HCM Risk-SCD model from 0.72 to 0.81 (p<0.05), with a relative integrated discrimination improvement of 0.002 (p<0.001) and net reclassification improvement of 0.67 (p<0.001). Furthermore, log NT-proBNP levels were significantly correlated with cardiac fibrosis as detected either by LGE (r=0.257, p<0.001) or by Masson’s trichrome staining in the myocardium (r=0.198, p<0.05).ConclusionNT-proBNP is an independent predictor of SCD in patients with HCM and may help with risk stratification of this disease.

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Calcium Channel Autoantibodies Predicted Sudden Cardiac Death and All-Cause Mortality in Patients with Ischemic and Nonischemic Chronic Heart Failure

Disease Markers ◽

10.1155/2014/796075 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Haiyun Yu ◽

Juanhui Pei ◽

Xiaoyan Liu ◽

Jingzhou Chen ◽

Xian Li ◽

...

Keyword(s):

Heart Failure ◽

Multivariate Analysis ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Cardiac Death ◽

Independent Predictor ◽

All Cause Mortality ◽

Patient Prognosis ◽

The Relationship

The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. A total of 2096 patients with CHF (841 DCM patients and 1255 ICM patients) and 834 control subjects were recruited. CC-AAbs were detected and the relationship between CC-AAbs and patient prognosis was analyzed. During a median follow-up time of 52 months, there were 578 deaths. Of these, sudden cardiac death (SCD) occurred in 102 cases of DCM and 121 cases of ICM. The presence of CC-AAbs in patients was significantly higher than that of controls (bothP<0.001). Multivariate analysis revealed that positive CC-AAbs could predict SCD (HR 3.191, 95% CI 1.598–6.369 for DCM; HR 2.805, 95% CI 1.488–5.288 for ICM) and all-cause mortality (HR 1.733, 95% CI 1.042–2.883 for DCM; HR 2.219, 95% CI 1.461–3.371 for ICM) in CHF patients. A significant association between CC-AAbs and non-SCD (NSCD) was found in ICM patients (HR = 1.887, 95% CI 1.081–3.293). Our results demonstrated that the presence of CC-AAbs was higher in CHF patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients.

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Sudden Cardiac Death in Patients with Chronic Heart Failure-Epidemiological Findings From the CHART Study

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2009.07.207 ◽

2009 ◽

Vol 15 (7) ◽

pp. S141

Author(s):

Nobuyuki Shiba ◽

Kotaro Nochioka ◽

Jun Watanabe ◽

Tomohiro Tada ◽

Haruka Kohno ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Chronic Heart Failure ◽

Cardiac Death

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Abstract 2415: Long-Term Baroreflex Activation Therapy Increases the Threshold for the Induction of Lethal Ventricular Arrhythmias in Dogs with Chronic Advanced Heart Failure

Circulation ◽

10.1161/circ.118.suppl_18.s_722 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Mengjun Wang ◽

Valerio Zaca ◽

Alice Jiang ◽

Itamar Ilsar ◽

Matthew Ebinger ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Lv Function ◽

Baroreflex Activation Therapy ◽

Increased Risk ◽

Lv Remodeling ◽

Activation Therapy

Heart failure (HF) is associated with a high incidence of ventricular tachycardia (VT) and fibrillation (VF). Patients with HF in whom these lethal arrhythmias can be induced by electrophysiological (EP) testing carry a high risk of sudden cardiac death. We showed that chronic electrical carotid baroreflex activation therapy (BAT) with the Rheos® System (CVRx, Inc.) improves LV function, attenuates LV remodeling and restores autonomic sympathetic-parasympathetic balance in dogs with HF. This study examined the effects of long-term therapy with BAT on the induction of VT or VF in dogs with coronary microembolization-induced HF (LV ejection fraction ~20%). Eleven dogs with HF underwent EP testing at baseline prior to therapy and after 3 and 6 months of therapy with BAT and again 6 weeks after withdrawal of BAT therapy (n = 7) or no therapy at all (Control, n = 4). Programmed ventricular stimulation was performed from the right ventricular apex and included delivery of up to 4 extrastimuli at progressively shorter coupling intervals (in steps of 10 msec). The extrastimuli were delivered following 8 ventricular paced beats with a drive cycle length between 600 and 200 msec. If a sustained monomorphic VT or VF could not be induced, isoproterenol infusion was initiated to increase the sinus rate by ~30% and the EP stimulation protocol was repeated. At baseline, a sustained VT or VF was induced in all 11 dogs (100%). After 3 and 6 months of follow-up, all Control dogs (100%) were induced into sustained VT or VF. After 3 months of BAT, only 3 of 7 dogs (43%) were induced into sustained VT or VF. After 6 months of BAT, only 2 of 7 dogs (29%) were induced into sustained VT or VF. Finally after withdrawal of BAT therapy, all dogs (100%) were again induced into systained VT or VF. In addition to improving LV function and attenuating LV remodeling, long-term monotherapy with BAT markedly increases the threshold for lethal ventricular arrhythmias in dogs with chronic HF. This is a marked improvement over inducibility of lethal arrhythmias seen in historical untreated controls. This benefit of BAT supports the continued exploration of this device as a therapeutic modality for treating patients with chronic HF and increased risk of sudden cardiac death.

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