B-Type Natriuretic Peptide Is a Major Predictor of Ventricular Tachyarrhythmias

Study Questions:

Are either N-terminal pro-B-type natriuretic peptide (NT-proBNP) or BNP independent predictors of ventricular arrhythmias in patients receiving primary prevention implantable cardioverter-defibrillators (ICDs)?

Methods:

One hundred sixty-one patients with NT-proBNP levels and 403 patients with BNP levels at the time of ICD implantation were retrospectively assessed for the occurrence of first appropriate ICD therapy and mortality.

Results:

In multivariable Cox proportional hazards regression analysis, NT-proBNP or BNP levels in the upper 50th percentile were the strongest predictor of ICD therapy after adjustment for sex, age, left ventricular ejection fraction, New York Heart Association class, history of coronary artery disease, blood urea nitrogen, creatinine clearance, and history of atrial fibrillation (hazard ratio [HR], 5.75; p < 0.001 for NT-proBNP; HR, 3.40; p = 0.01 for BNP). Patients were divided into quartiles on the basis of NT-proBNP or BNP levels. The adjusted HR for ICD therapy in the highest and second highest quartiles of NT-proBNP levels (HR, 12.9; p < 0.001, and HR, 4.6; p = 0.03, respectively) were higher than the adjusted HR for total mortality in these two quartiles (HR, 3.4; p = 0.021 and HR, 2.3; p = 0.13, respectively). Similarly, the adjusted HR for ICD therapy in the highest and second highest quartiles of BNP levels (HR, 4.74; p = 0.01 and HR, 2.17; p = 0.04, respectively) were higher than the adjusted HR for total mortality in these two quartiles (HR, 3.05; p = 0.01 and HR, 1.07; p = 0.3, respectively).

Conclusions:

In this study, elevated baseline NT-proBNP and BNP levels are independently associated with the risk for ventricular tachyarrhythmias, which significantly exceeds the risk for total mortality, in multivariable analysis.

Perspective:

Consistent with other studies, the current study found an association between elevated BNP and its prohormone NT-proBNP levels and mortality. In this retrospective analysis of a primary prevention ICD cohort, the association of the biomarker levels with ventricular tachyarrhythmias was even more significant. The measurement of these peptides should be incorporated in future prospective studies. It is conceivable that NT-proBNP and BNP may be one day used to improve risk stratification of patients considered for ICD implantation.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Coronary Artery Disease, Biological Markers, Peptide Fragments, Blood Urea Nitrogen, Stroke Volume, Creatinine, Regression Analysis, Defibrillators, Implantable, Primary Prevention, Tachycardia, Natriuretic Peptide, Brain


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