P-072 The development of malignant ventricular arrhythmia in patients with ischemic cardiomyopathy and the prognostic significance of NT-proBNP

Abstract

Purpose A significant new cardiac marker in the prognosis of ischemic cardiomyopathy N-terminal pro brain natriuretic peptide (NT-proBNP) has recently been reported. Given the high incidence of sudden death in patients with congestive heart failure we examined the value of NT-proBNP in predicting the occurrence of malignant arrhythmias in patients with implantable cardioverter-defibrillators. Methods Baseline plasma concentrations of NT-proBNP were measured using ELISA in 25 patients (mean age 66±8 years) with ischemic cardiomyopathy and a left ventricular ejection fraction ≤35%. In all patients an internal cardioverter-defibrillator had been implanted for primary prevention of sudden death according to MADIT I criteria. Results The implantable cardiac defibrillators were interrogated at 1-year follow-up to identify the type of arrhythmias patients had developed. NT-proBNP concentrations were significantly higher in patients who developed sustained monomorphic ventricular tachycardia (SVT) or ventricular fibrillation (VF) compared with those having only episodes of non-sustained ventricular tachycardia (NSVT), (1024 ± 462 vs. 675 ± 320 pmol/L). By regression analysis, NT-proBNP was found to be a powerful predictor of sustained monomorphic ventricular tachycardia (R=0.423, p=0.035). Conclusion Increased circulating levels of NT-proBNP predict the appearance of sustained ventricular tachycardia and may serve as an additional criterion defining patients at high risk for sudden cardiac death.