title: Prognostic role of high-sensitivity C-reactive protein and B-type natriuretic peptide in implantable cardioverter-defibrillator patients.
abstract: BACKGROUND
  High-sensitivity C-reactive protein (hs-CRP) and B-type natriuretic peptide (BNP) are useful biomarkers for cardiovascular risk stratification. Little data are available regarding the prognostic value of hs-CRP and BNP serum levels and future ventricular arrhythmic events triggering implantable cardioverter defibrillator (ICD) therapy.
  
  
  METHODS
  A total of 100 patients eligible for ICD implantation were enrolled in a prospective cohort study. Serum levels of hs-CRP and BNP were obtained the day before ICD implantation and at scheduled follow-up visits. For risk analysis, the study cohort was dichotomized based on serum level of hs-CRP using a cut-off value of 3 mg/L. The endpoint was appropriate ICD therapy triggered by ventricular arrhythmias during a follow-up of 24 months.
  
  
  RESULTS
  Appropriate ICD therapy was delivered in 20% of patients. Median baseline serum level of hs-CRP was significantly higher in patients with appropriate ICD therapy than in those without appropriate ICD therapy (5.33 mg/L vs 2.19 mg/L; P = 0.002). The same was true for median serum levels of hs-CRP and BNP during follow-up (5.43 mg/L vs 2.61 mg/L, P = 0.001 and 261.0 pg/mL vs 80.1 pg/mL, P = 0.01, respectively). Multivariate analysis demonstrated that baseline hs-CRP level > 3 mg/L was independently associated with appropriate ICD therapy (odds ratio 4.0, 95% 1.1-14.2; P = 0.03).
  
  
  CONCLUSIONS
  Elevated preimplantation hs-CRP serum level is independently associated with increased risk for appropriate ICD therapy. Monitoring for elevated BNP levels during follow-up adds to the assessment of risk for future arrhythmias.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. d.theuns@erasmusmc.nl
authors.forename: Dominic A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: Tim
authors.initials: T
authors.lastname: Smith
authors.forename: Tamas
authors.initials: T
authors.lastname: Szili-Torok
authors.forename: Agnes
authors.initials: A
authors.lastname: Muskens-Heemskerk
authors.forename: Petter
authors.initials: P
authors.lastname: Janse
authors.forename: Luc
authors.initials: L
authors.lastname: Jordaens
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012306:Risk; D017180:Tachycardia, Ventricular / Q000097:blood* / Q000628:therapy*
chemical_list: D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein