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Clinical Investigations: CARDIOLOGY |

Amino-Terminal Pro-Brain Natriuretic Peptide Predicts Ventricular Arrhythmogenesis in Patients With Ischemic Cardiomyopathy and Implantable Cardioverter-Defibrillators*

Emmanuel G. Manios, MD; Eleftherios M. Kallergis, MD; Emmanuel M. Kanoupakis, MD; Hercules E. Mavrakis, MD; Despina C. Kambouraki, MD; Dimitris A. Arfanakis, MD; Panos E. Vardas, MD, PhD
Author and Funding Information

*From the Department of Cardiology, University Hospital of Heraklion, Crete, Greece.

Correspondence to: Emmanuel Manios, MD, Department of Cardiology, Heraklion University Hospital, 71000, Voutes, Heraklion-Crete, Greece; e-mail: mman@med.uoc.gr



Chest. 2005;128(4):2604-2610. doi:10.1378/chest.128.4.2604
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Study objectives: Even in high-risk population groups, not all patients have the same risk of sudden cardiac death (SCD). Given the emerging data about the amino-terminal fragment of the brain natriuretic peptide prohormone (NT-proBNP) value in heart failure, we planned to evaluate the importance of NT-proBNP levels in predicting the occurrence of malignant arrhythmias in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillators (ICDs).

Design: Prospective study.

Setting: Tertiary referral center.

Patients: Thirty five ambulatory patients with previous myocardial infarction, left ventricular ejection fraction < 35%, and ICDs for primary prevention of SCD according to Multicenter Automatic Defibrillator Implantation Trial I criteria.

Interventions: Venous blood samples for plasma NT-proBNP measurement were obtained after 30 min of supine rest from all patients at the beginning of the study. Patients were evaluated every 2 months, or sooner in cases of device discharges, during a 1-year follow-up period. Data concerning arrhythmias and device therapy were stored at the time of device interrogation on each follow-up visit.

Measurements and results: During 1-year follow-up, 11 of 35 patients (31.4%) received 18 antiarrhythmic device therapies for ventricular tachyarrhythmia (VT). Patients who experienced such arrhythmias had NT-proBNP levels of 997.27 ± 335.14 pmol/L (mean ± SD), whereas those without VT had NT-proBNP levels of 654.87 ± 237.87 pmol/L (p = 0.001). An NT-proBNP cutoff value of 880 pmol/L had a sensitivity of 73%, a specificity of 88%, a positive predictive value of 80%, and a negative predictive value of 88% for the prediction of occurrence-sustained VT events.

Conclusion: To achieve the maximum benefit by ICD therapy, more precise risk stratification is required, even in high-risk, post-myocardial infarction patients. Plasma NT-proBNP levels comprise a promising method that could help in the better identification of a patient group with an even higher risk of sudden death.

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