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

Abstract

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 N 26 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 N 26 mm/m2 and NT-proBNP N 908 ng/L increased the risk of SCD (HR 4.3; 95% CI 2.5-7.6; p b 0.0001). 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 N 26 mm/m 2 and NT-proBNP N 908 ng/L reached 25% (p b 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.

Relationship Between Adiponectin and Left Atrium Size in Uncomplicated Obese Patients: Adiponectin, a Link Between Fat and Heart

“…On the contrary, LV mass, IVS, and LA size were significantly larger in the obese group. Furthermore, cardiac output was significantly increased in the obese group, in agreement with hyperdynamic circulation [9][10][11]. Structural parameters such as the systolic and diastolic volumes and diameters were all significantly larger than those of the controls, in accordance with the literature [13,14].…”

“…Morbid obesity is associated with hyperdynamic circulation and hypervolemia, leading to elevated left ventricle (LV) filling pressures [9][10][11]. The latter often leads to left atrium (LA) enlargement, as one of the earliest manifestations of left ventricle diastolic dysfunction (LVDD).…”

Multi-Ethnic Study of Atherosclerosis: Association between Left Atrial Function Using Tissue Tracking from Cine MR Imaging and Myocardial Fibrosis

“…LA EF was also significantly decreased; that can be explained by the increase in V min and similarity in V max . Although increased V max is an important prognostic predictor in various cardiac diseases (1)(2)(3)12,32,33), evaluating V min and LA EF might aid in detecting early, subclinical LA filling impairment. We demonstrated that LA strain and strain rate were significantly different between the subclinical myocardial scar group and the control group.…”

Prognostic value of increased carbohydrate antigen in patients with heart failure

“…Numerous studies have examined the value of natriuretic peptides to assess the prognosis of HF [33][34][35][36] , most of them performed in the emergency room or in patients with acute decompensated HF requiring hospitalization. Few of the studies focus on stable chronic HF [37,38] .…”