B‐type Natruiretic Peptide Levels Stratify the Risk for Arrhythmia Among Implantable Cardioverter Defibrillator Patients

Abstract

Background: We sought to study the association between brain natriuretic peptide (BNP) levels and the occurrence of ventricular arrhythmias in patients with left ventricular dysfunction (LVD) and an implantable cardioverter defibrillator (ICD). Methods: This was a prospective study of consecutive, stable, ambulatory patients with moderate and severe ischemic LVD and an ICD. A plasma BNP level was obtained at recruitment. Patients were evaluated every 3-6 mo for a minimum of 1 y. The primary end point was the occurrence of malignant ventricular arrhythmia or sudden cardiac death (SCD). Results: The cohort consisted of 94 subjects (6 women) with a mean±standard deviation (SD) age of 69±10 y. The ICD implantation indication was primary and secondary prevention of SCD in 49% and 51% of subjects, respectively. A primary end point occurred in 27 patients (29%), and was more frequent in symptomatic heart failure patients and those implanted for secondary prevention of SCD. The median BNP level was significantly higher among patients who experienced an end point (191 pg/ml versus 142 pg/ml, p = 0.03). After controlling for New York Heart Association heart failure class and ICD implantation indication, the odds ratio (OR) for experiencing an adverse outcome among the upper BNP quartile versus all others was 3.5 (95% confidence interval [CI]: 1.2-10.2). Among patients implanted for primary prevention of SCD, none of the patients in the lower BNP quartile (BNP <91 pg/ml) experienced an adverse outcome. Conclusions: These results suggest that abnormally high BNP levels not only predict cardiac death, but also arrhythmic death in this patient population, and a low BNP level can serve to identify low risk patients.

Predictors of Sudden Cardiac Death in Doberman Pinschers with Dilated Cardiomyopathy

“…This result corresponds with previous studies reporting cTnI concentration measurement as a useful additional test to Holter‐ECG and echocardiography . Some authors recommend measuring cardiac biomarkers in humans for SCD risk assessment, because high cardiac biomarker concentrations were found to predict SCD in their studies populations …”

“…8 Some authors recommend measuring cardiac biomarkers in humans for SCD risk assessment, because high cardiac biomarker concentrations were found to predict SCD in their studies populations. 20,21 Conditional inference trees are constructed in a greedy manner, which means that the statistical software picks the most important variable for each step. Variables that have a high correlation and thus provide similar information are therefore not showing up in the CTREEs, as adding another nodal point would not result in additional information.…”

“…However, EF alone is insufficient to predict SCD, because many patients who die of SCD show no systolic dysfunction in the first place . Hence, additional variables for risk evaluation are currently investigated, such as electrophysiology testing, signal‐averaged electrocardiography, cardiac magnetic resonance imaging, and measurement of cardiac biomarker concentrations . Currently, there is no consensus or general recommendation which additional variables should be used, but a combination of cardiac magnetic resonance imaging and electrophysiology testing appears to be promising in human medicine field.…”

“…16,17 Hence, additional variables for risk evaluation are currently investigated, such as electrophysiology testing, 18 signal-averaged electrocardiography, 19 cardiac magnetic resonance imaging, 18 and measurement of cardiac biomarker concentrations. 20,21 Currently, there is no consensus or general recommendation which additional variables should be used, but a combination of cardiac magnetic resonance imaging and electrophysiology testing appears to be promising in human medicine field. However, any of the above methods are still critically discussed, so that further studies are warranted.…”

Primary Outcomes for Resuscitation Science Studies

“…26 In a cohort of patients who received implantable cardioverter-defibrillators for secondary prevention of sudden cardiac death, elevated brain natriuretic peptide and New York Heart Association functional class were associated with clinical end points, including ventricular arrhythmia or sudden death. 27,28 Long-term myocardial recovery may be particularly sensitive to post-ROSC interventions such as revascularization, pharmacotherapy, and implantable cardioverter-defibrillators. For example, survival until a second episode of VF and sudden death must be defined differently for patients with or without implantable cardioverter-defibrillators.…”