N-Terminal Pro-B-Type Natriuretic Peptide in Risk Stratification of Heart Failure Patients With Implantable Cardioverter-Defibrillator

Frontiers in Cardiovascular Medicine

article

Yu Deng¹  Si-Jing Cheng¹  Wei Hua¹  Min-Si Cai¹  Ni-Xiao Zhang¹  Hong-Xia Niu¹  Xu-Hua Chen¹  Min Gu¹  Chi Cai¹  Xi Liu¹  Hao Huang¹  Shu Zhang¹ 

[1] Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College

关键词: N-terminal pro-B-type natriuretic peptide;    heart failure;    implantable cardioverter-defibrillator;    all-cause mortality;    appropriate defibrillator shock;    restricted cubic spline;   

DOI  :  10.3389/fcvm.2022.823076

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background The prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure (HF) is well-established. However, whether it could facilitate the risk stratification of HF patients with implantable cardioverter-defibrillator (ICD) is still unclear. Objective To determine the associations between baseline NT-proBNP and outcomes of all-cause mortality and first appropriate shock due to sustained ventricular tachycardia/ventricular fibrillation (VT/VF) in ICD recipients. Methods and results N-terminal pro-B-type natriuretic peptide was measured before ICD implant in 500 patients (mean age 60.2 ± 12.0 years; 415 (83.0%) men; 231 (46.2%) Non-ischemic dilated cardiomyopathy (DCM); 136 (27.2%) primary prevention). The median NT-proBNP was 854.3 pg/ml (interquartile range [IQR]: 402.0 to 1,817.8 pg/ml). We categorized NT-proBNP levels into quartiles and used a restricted cubic spline to evaluate its nonlinear association with outcomes. The incidence rates of mortality and first appropriate shock were 5.6 and 9.1%, respectively. After adjusting for confounding factors, multivariable Cox regression showed a rise in NT-proBNP was associated with an increased risk of all-cause mortality. Compared with the lowest quartile, the hazard ratios (HRs) with 95% CI across increasing quartiles were 1.77 (0.71, 4.43), 3.98 (1.71, 9.25), and 5.90 (2.43, 14.30) for NT-proBNP ( p for trend 0.05). No nonlinearity was found, either ( p = 0.666). Interactions between NT-proBNP and predefined factors were not found (all p > 0.1). Conclusion In HF patients with ICD, the rise in NT-proBNP is independently associated with increased mortality until it reaches the inflection point. However, its association with the first appropriate shock was not found. Patients with higher NT-proBNP levels might derive less benefit from ICD implant.

【 授权许可】

CC BY