Abstract
Background: Internal cardioverter defibrillator (ICD) therapy reduced all-cause mortality. Conversely, few studies reported that ICDs' shocks may reduce survival. Recently authors suggested that, multiple inflammatory and molecular pathways were related to worse prognosis in metabolic syndrome (MS) patients treated by ICDs. Therefore, it may be relevant to find new biomarkers to predict ICDs' shock and worse prognosis in treated patients.Methods: In 99 MS vs. 107 no MS patients treated by ICD for primary prevention, we evaluated all-cause mortality, cardiac deaths, hospitalization for heart failure, appropriate and inappropriate therapy, and survival after appropriate ICD therapy.Results: MS vs. no MS patients had higher levels of failing heart stress biomarkers. The highest values of ST2 were related to worse prognosis. Patients who had better survival after appropriate ICD therapy were those associated with lowest ST2 values. At multivariate Cox regression analysis, C reactive protein (CRP) (0.110 [0.027–0.446], p-value 0.002), troponine I (TnI) protein (0.010 [0.001–0.051], p-value 0.010), and B type natriuretic peptide (BNP) (1.151 [1.010–1.510], p-value 0.001), predicted all cause of deaths. BNP predicted cardiac deaths (1.010 [1.001–1.206], p-value 0.033). MS, and BNP predicted hospitalization for heart failure events (2.902 [1.345–4.795], p-value 0.001; 1.005 [1.000–1.016], p-value 0.007). ST2 predicted appropriate therapy (1.012 [1.007–1.260], p-value 0.001), as BNP (1.005 [1.001–1.160], p-value 0.028), LVEF (1.902 [1.857–1.950], p-value 0.001), and CRP (1.833 [1.878–1.993], p-value 0.028). ST2, and BNP predicted survival after ICD appropriate therapy (4.297 [1.985–9.302], p-value 0.001; 1.210 [1.072–1.685], p-value 0.024).Conclusions: ST2 values may differentiate MS patients with a higher risk of ICDs' therapy, and worse prognosis. Therefore, ST2 protein may be used as valid monitoring biomarker, and as a predictive biomarker in failing heart ICDs' patients affected by MS.
Highlights
Few years ago authors reported that, in a population of 1,232 post-ischemic patients with a left ventricle ejection fraction (LVEF) ≤30%, the implantation of internal cardioverter defibrillator (ICD) for primary prevention therapy brought to a 31% reduction of all-cause mortality (Moss et al, 2002)
In this table we reported number of events of the study outcomes experienced in Metabolic Syndrome (MS) vs. controls, and in internal cardioverter defibrillator single chamber (ICD-single chamber implantable cardioverter-defibrillator (VVI)) vs. internal cardioverter defibrillator dual chambers (ICD-dual chambers implantable cardioverter-defibrillator (DDD))
Highest ST2 protein (ST2) values may be linked to a major rate of hospitalization, and ICDs’ therapies, while on the contrary lowest ST2 values may be predictive of higher rate of survival after ICD appropriate therapy
Summary
Few years ago authors reported that, in a population of 1,232 post-ischemic patients with a left ventricle ejection fraction (LVEF) ≤30%, the implantation of internal cardioverter defibrillator (ICD) for primary prevention therapy brought to a 31% reduction of all-cause mortality (Moss et al, 2002). As first the occurrence of ICDs’ shocks has been associated to worse prognosis (Proietti et al, 2015) Secondary, this risk appeared to be greater for appropriate than inappropriate shocks (Proietti et al, 2015). In the clinical practice this may be translated in the opportunity to avoid the subsequent cardiac pump failure observed in patients after ICD therapy, and the related worse clinical prognosis, such as augmented hospitalizations, and deaths events (Proietti et al, 2015). It may be relevant to find new biomarkers to predict ICDs’ shock and worse prognosis in treated patients
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
