N-terminal pro-B-type natriuretic peptide for prediction of ventricular arrhythmias: data from the SMASH Study

Abstract

Abstract Background Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations predict heart failure (HF) and mortality, but whether NT-proBNP predicts ventricular arrhythmias (VA) is not clear. Purpose We hypothesize that high NT-proBNP concentrations associate with the risk of incident VA, defined as adjudicated ventricular fibrillation or sustained ventricular tachycardia. Methods In a prospective, observational study of patients treated with implantable cardioverter defibrillator (ICD), we analyzed NT-proBNP concentrations at baseline and after mean 1.4 years in association to incident VA. Results We included 491 patients (age 66±12 years, 83% men) out of whom 51% had a primary prevention ICD indication. The median NT-proBNP concentration was 567 (25-75 percentile 203-1480) ng/L, and patients with higher concentrations were older with more HF and ICD for primary prevention. During mean 3.1±0.7 years, 136 patients (28%) had ≥1 VA. Baseline NT-proBNP concentrations were associated with risk of incident VA (HR 1.39 [95%CI 1.22-1.58], p<0.001) (Figure1), HF hospitalizations (HR 3.38 [95%CI 2.69-4.25], p<0.001) and all-cause mortality (HR 2.49 [2.05-3.04], p<0.001) (Figure2), which persisted after adjusting for age, sex, BMI, CAD, HF, renal function, and LVEF. The association with VA was stronger in secondary vs primary prevention ICD indication: HR 1.59 (95% CI 1.34-1.88 C-statistics 0.71) vs HR 1.25 (1.02-1.52, C-statistics 0.55), p-for-interaction=0.06. Changes in NT-proBNP during the first 1.4 years did not associate with subsequent VA. Conclusions NT-proBNP concentrations are associated with the risk of incident VA after adjustment for established risk factors, with the strongest association in patients with a secondary prevention ICD indication.