High NT-proBNP concentrations may predict ventricular arrhythmias
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Key takeaways:
- NT-proBNP concentration is a strong predictor of ventricular arrhythmias among people with an implantable device.
- The association was stronger for people with a secondary indication for an ICD.
Patients with an implantable cardioverter defibrillator and high N-terminal pro-B type natriuretic peptide level have elevated odds of developing a ventricular arrhythmia during follow-up, data show.
“Most studies have analyzed NT‐proBNP in association with clinically suspected sudden cardiac death and few have investigated the association with recordings of ventricular arrhythmia, which is an outcome measure more relevant for risk stratification and patient selection for ICD treatment,” Peder L. Myhre, MD, PhD, of the division of medicine at Akershus University Hospital, Lørenskog, Norway, and colleagues wrote in Clinical Cardiology. “HF with reduced left ventricular ejection fraction is the most frequent primary prevention ICD indication, and these patients therefore typically have higher NT‐proBNP concentrations than patients with a secondary prevention ICD indication.”
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Myhre and colleagues analyzed data from 490 patients treated with ICDs who participated in the prospective, observational SMASH study. Researchers assessed NT‐proBNP concentrations at baseline and after a mean 1.4 years. The mean age of patients was 66 years and 83% were men, and 51% had a primary prevention ICD indication.
The median NT‐proBNP concentration was 567 ng/L (interquartile range, 203-1,480). Patients with higher concentrations were older, more likely to have advanced HF and more likely to have an ICD for primary prevention.
During a mean 3.1 years of follow-up, 28% of patients experienced at least one ventricular arrhythmia.
Baseline NT‐proBNP concentrations were associated with risk for time-to-first incident ventricular arrhythmia, with an HR per log unit increase of 1.39 (95% CI, 1.22-1.58; P < .001). Patients in the highest quartile of NT-proBNP had an almost fourfold higher risk for ventricular arrhythmia compared with patients in the lowest quartile (HR = 3.86; 95% CI, 2.1-7.1; P < .001).
Additionally, researchers observed that higher baseline NT-proBNP concentration was also associated with HF hospitalizations (HR per log unit increase = 3.11; 95% CI, 2.53-3.82; P < .001), and all‐cause mortality (HR per log unit increase = 2.49; 95% CI, 2.04-3.03; P < .001). Results persisted after adjustment for age, sex, BMI, coronary artery disease, HF, renal function and left ventricular ejection fraction.
The association with ventricular arrhythmia was stronger among patients with a secondary ICD indication (HR = 1.59; 95% CI, 1.34-1.88; C‐statistic, 0.71) compared with patients who had a primary ICD indication (HR = 1.24; 95% CI, 1.02-1.51; C‐statistic, 0.55; P for interaction = .06).
Changes in NT‐proBNP during the first 1.4 years were not associated with subsequent ventricular arrhythmia, according to the researchers.
“NT‐proBNP is a noninvasive test that is widely available and reproducible,” the researchers wrote. “Our data suggest that NT‐proBNP may be a helpful tool for assessing [ventricular arrhythmia] risk, particularly in patients with a secondary ICD indication.”
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