N-terminal pro-B-type natriuretic peptide and sudden cardiac death risk: implications for primary prevention of sudden cardiac death.

摘要

Over the last several decades, significant advances have been made in the treatment of cardiovascular disease. However, despite these advances, the majority of cardiovascular disease deaths occur suddenly outside of the hospital or in the emergency room,1 and survival rates from cardiac arrest remain poor despite advances in resuscitation.2 Thus, early identification of subjects at risk for sudden cardiac death (SCD) and effective primary prevention strategies will be essential to further reducing mortality from cardiovascular disease. However, it is well known that our current risk stratification approach, which uses left ventricular ejection fraction (LVEF) and clinical symptoms of congestive heart failure (CHF) to identify individuals at risk, does not identify the majority of individuals who later will go on to suffer SCD. Not only do the majority of these individuals not have documented depressed LVEF,3 but more than half have no clinically recognized heart disease prior to the SCD.4'5 Therefore, in order to have a significant impact on SCD incidence, we need to address SCD prevention in broader populations. Blood-based markers, which could easily be measured in large, relatively well populations, may further our understanding of the biologic underpinnings of SCD within lower-risk populations and ultimately improve SCD risk prediction.