title: Brain natriuretic peptide and the risk of ventricular tachyarrhythmias in mildly symptomatic heart failure patients enrolled in MADIT-CRT.
abstract: BACKGROUND
  There are limited data about the correlation between brain natriuretic peptide (BNP) levels and arrhythmic risk assessment in patients who receive device therapy for the treatment of heart failure (HF) or for the prevention of sudden cardiac death.
  
  
  OBJECTIVE
  We aimed to investigate the association between BNP levels and the risk of ventricular tachyarrhythmias among mildly symptomatic HF patients who receive an intracardiac defibrillator (ICD) with or without cardiac resynchronization therapy (respectively, CRT-D or CRT).
  
  
  METHODS
  The study population involved 1197 patients enrolled in MADIT-CRT. Plasma BNP was measured in a core laboratory at baseline and after 1-year follow-up. Ventricular tachycardia/fibrillation (VT/VF) events were identified from ICD/CRT-D interrogations.
  
  
  RESULTS
  Multivariate Cox hazards regression modeling showed that elevated baseline (> median = 72 ng/L) and 1-year BNP were associated with a significant increase in the risk of VT/VF (HR = 1.36, P = .026; and HR = 1.79, P < .001, respectively); and VT/VF or death (HR = 1.37, P = .008; and HR = 1.84, P < .0001, respectively) during follow-up. At 1 year post device implantation, BNP levels were significantly lower among study patients treated with CRT-D as compared with those who received ICD only (P = .014). CRT-D patients who had greater than median reductions in BNP levels (greater than one-third reduction of initial value) experienced a significantly lower risk of subsequent VT/VF (HR = 0.61, P = .021) and VT/VF or death (HR = 0.45, P < .0001) as compared to patients without such reductions.
  
  
  CONCLUSIONS
  In MADIT-CRT, elevated baseline and follow-up BNP levels were independent predictors of increased risk for subsequent ventricular tachyarrhythmias, whereas BNP reductions following CRT-D implantation identified patients with a lower incidence of VT/VF during follow-up.
authors.affiliation: Shaare Zedek Medical Center, Cardiology, Jerusalem, Israel; Hebrew University Hadassah Medical School, Jerusalem, Israel. Electronic address: aharonm@ekmd.huji.ac.il.
authors.forename: Aharon
authors.initials: A
authors.lastname: Medina
authors.affiliation: University of Rochester Medical Center, Cardiology Division, Rochester, New York.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: University of Rochester Medical Center, Cardiology Division, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: University of Rochester Medical Center, Cardiology Division, Rochester, New York.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Stanford University School of Medicine, Cardiology Division, Palo Alto, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Wang
authors.affiliation: University of Rochester Medical Center, Cardiology Division, Rochester, New York; Sheba Medical Center, Neufled Cardiac Research Institute, Ramat Gan, Israel; Tel Aviv University, Sackler Medical School, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002170:Canada / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Brain natriuretic peptide; Cardiac resynchronization therapy; Implantable cardioverter-defibrillator; Reverse remodeling; Ventricular arrhythmia