title: Amino-terminal pro-brain natriuretic peptide predicts ventricular arrhythmogenesis in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillators.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, University Hospital of Heraklion, 71000, Voutes, Heraklion-Crete, Greece. mman@med.uoc.gr
authors.forename: Emmanuel G
authors.initials: EG
authors.lastname: Manios
authors.forename: Eleftherios M
authors.initials: EM
authors.lastname: Kallergis
authors.forename: Emmanuel M
authors.initials: EM
authors.lastname: Kanoupakis
authors.forename: Hercules E
authors.initials: HE
authors.lastname: Mavrakis
authors.forename: Despina C
authors.initials: DC
authors.lastname: Kambouraki
authors.forename: Dimitris A
authors.initials: DA
authors.lastname: Arfanakis
authors.forename: Panos E
authors.initials: PE
authors.lastname: Vardas
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D009202:Cardiomyopathies / Q000097:blood / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D017180:Tachycardia, Ventricular / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain