Evaluation of the Prognostic Value of BNP in Prediction of Sudden Cardiac Death in Patients with Left Ventricular Dysfunction after an Acute MI

Abstract
Background: Sudden Cardiac Death (SCD) is still a challenge despite advances in diagnostic and therapeutic and inspite of effectiveness of Implantable Cardioverter Defibril-lators (ICDs), a better identification of patients with depressed ventricular function who could benefit from an ICD or, perhaps more importantly, those who are unlikely to benefit would helpin their management.
Aim of Study: Was To assess the prognostic value of B-type Natriuretic Peptide (BNP), in predicting sudden cardiac death within 90 days from the onset of MI in pts who developed LV dysfunction in this period.
Methods: We measured NT pro BNP in 60 consecutive post-STEMI patients with LV systolic dysfunction (<EF 50%), (45 men, represents 75% with mean age 57.6±8.4 years old), 3 to 5 days after onset chest pain.
Results: Mean age of studied patients was 57.6±8.4 years old (range 35-80). Males constituted 73.3% of our study population (44 males), we found mean NYHA 2.8, mean Killip class of 2.9 and mean TIMI risk score of 8.3. Follow-up was done at 90 days. Forty eight patients survived (80%), of whom life-threatening arrhythmias was documented in seven patients (11.7%), 12 pts had SCD (20%). Pro-BNP as evidenced as a useful marker in predicting SCD by plotting the ROC curve that revealed AUC for 0.775 for prediction of sudden cardiac death, while AUC was 69.6% of ROC curve of same neuropeptide in evaluating accuracy in prediction VT, by. Kaplan Meier analysis shows that rise of pro-BNP above 3.2ng/ml has a significant predictive impact upon SCD, [OR 0.748 (CI 95%: 0.07-0.932), p-value .039].
Conclusion: BNP levels are a strong, independent predictor of sudden death in patients with ischemic cardiomyopathy after an acute MI.