Increased ventricular ectopic activity in relation to C-reactive protein, and NT-pro-brain natriuretic peptide in subjects with no apparent heart disease.
BACKGROUND
Subjects with frequent ventricular premature complexes (VPC) and no apparent heart disease make a heterogenic group with regard to prognosis. Some biomarkers have recently proved useful in risk stratification in different heart diseases. We examined prognostic impact of NT-Pro-brain natriuretic peptide (NT-Pro BNP), and C-reactive protein (CRP) in relation to frequent VPC in subjects with no apparent heart disease.


METHODS
Six hundred seventy-eight healthy subjects between 55 and 75 years of age with no history of cardiovascular disease were included in the study. All were tested with fasting laboratory testing and 48-hour ambulatory ECG monitoring. Frequent VPC was defined as VPC > or =30/hour.


RESULTS
In 56 subjects (8%) with frequent VPC the prognosis was much poorer compared to those without frequent VPC (Hazard ratio and 95% CI: 2.3;1.2-4.4, P = 0.01), after adjustment for conventional risk factors. In subjects with frequent VPC increased levels of CRP (above 2.5 microg/mL) was the only factor among the tested biomarkers, which was associated with a poor prognosis. Taking subjects without frequent VPC as reference, the hazard ratio and 95% CI for subjects with frequent VPC and increased CRP was 3.6;1.8-7.1, P = 0.0004, and for those with frequent VPC and normal CRP 0.8;0.2-3.5, P = 0.83, after correction for conventional risk factors.


CONCLUSIONS
Among middle-aged and elderly subjects with no apparent heart disease and frequent VPCs, a CRP value > or =2.5 microg/mL is associated with a significantly higher risk of death and acute myocardial infarction. These subjects deserve primary prevention measures and further work up for structural heart disease.
Sajadieh
Ahmad
A
Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke, Copenhagen NV, Denmark. ahs@dadlnet.dk
Nielsen
Olav Wendelboe
OW
Rasmussen
Verner
V
Ole Hein
Hans
H
Hansen
Jørgen Fischer
JF
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D015996:Survival Rate; D018879:Ventricular Premature Complexes / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein