Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure

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 N26 mm/m 2 (HR 2.8; 95% CI 1.5–5.0; p=0.0007), NT-proBNP N908 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 N26 mm/m2 and NT-proBNP N908 ng/L increased the risk of SCD (HR 4.3; 95% CI 2.5–7.6; pb0.0001). At 36 months, risk of SCD in patients with indexed LA size ≤26 mm/m 2 and NT-proBNP ≤908 ng/L was 3%, while in patients with indexed LA size N26 mm/m 2 and NT-proBNP N908 ng/L reached 25% (pb0.0001). Conclusions: Among HF patients, indexed LA size and NT-proBNP levels are more useful to stratify risk of SCD than other clinical, echocardiographicorbiochemicalvariables.ThecombinationofthesetwoparametersshouldbeconsideredforpredictingSCDinpatientswithHF.