title: [Noninvasive Electrophysiological Predictors and Biomarkers of Malignant Arrhythmias in Patients With Ischemic Heart Disease: a 2-Year Prospective Follow-up].
abstract: OBJECTIVE
  to assess prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with ischemic heart disease (IHD) during long-term follow-up as well as during myocardial revascularization surgery and early postoperative period.
  
  
  METHODS
  We prospectively enrolled 97 patients (mean age 61 ± 10 years) with angiographically confirmed coronary artery disease. Most patients (68%) had heart failure NYHA functional class II-III. Mean left ventricular ejection fraction (LVEF) was 50 ± 13%; 20% of patients had LVEF ≤ 35%. Sixty two patients had revascularization procedures during follow-up.
  
  
  METHODS
  We used 24-hour Holter monitoring and signal-averaged electrocardiography to obtain the following parameters: microvolt T-wave alternans, QT-interval duration and dynamics, heart rate turbulence (HRT) and variability. Laboratory tests included serum creatinine and creatinine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels. RESULTS. During mean follow-up period of 25 ± 11 months life-threatening ventricular arrhythmias were observed in 11 patients (11%). On univariate analysis, history of percutaneous coronary intervention (p < 0.05), history of malignant arrhythmias or syncope (p < 0.05), LVEF ≤ 47% (p < 0.01), left atrium size 24.7 cm (p < 0.05), left atrium index (p = 0.01), filtered QRS duration (p < 0.05), abnormal heart rate turbulence (HRT) (chi-square test = 6.2, p = 0.01), abnormal turbulence slope (chi-square test = 9.5, p < 0.01), BNP ≥ 158 picogram/ml (p < 0.01), NT-proBNP ≥ 787 rg/ml (chi-square test = 4.4, p < 0.05) were significantly associated with malignant arrhythmias in long-term follow-up. History of malignant arrhythmias or syncope (OR 11.1, 95% Cl 2.8-44.4; p < 0.01), abnormal HRT (OR 13.6, 95% Cl 2.8-66.1; p < 0.01), and plasma BNP ≥ 158 picogram/ml (OR 14.3, 95% CI 3.2-65.0; p < 0.01) were independent predictors of malignant arrhythmias on multivariate Cox regression analysis.
  
  
  CONCLUSIONS
  History of malignant arrhythmias, pathological HRT and plasma brain natriuretic peptide level ≥ 158 picogram/ml were independent predictors of malignant ventricular arrhythmias during 2 years follow-up of patients with IHD.
authors.forename: E Z
authors.initials: EZ
authors.lastname: Golukhova
authors.forename: O I
authors.initials: OI
authors.lastname: Gromova
authors.forename: V Yu
authors.initials: VY
authors.lastname: Merzlyakov
authors.forename: K V
authors.initials: KV
authors.lastname: Shumkov
authors.forename: N I
authors.initials: NI
authors.lastname: Bulaeva
authors.forename: L A
authors.initials: LA
authors.lastname: Bockeria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein