Simon Tobias, Becker Ruediger, Voss Frederik, Bikou Olympia, Hauck Melanie, Licka Manuela, Katus Hugo A, Bauer Alexander
Dept. of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Clin Res Cardiol. 2008 May;97(5):306-9. doi: 10.1007/s00392-007-0629-2. Epub 2008 Jan 14.
Patients with nonischemic cardiomyopathy (DCM) are at high risk for sudden cardiac death (SCD). However, the predictive value of prophylactic implantation of implantable cardioverter defibrillators (ICD) in this patient cohort is yet unclear.
Whether NT pro BNP levels and/or reproducible non sustained ventricular tachycardias (NSVTs) are predictive for SCD was prospectively tested in 30 patients with DCM and LVEF </= 40%. All patients received Holter-recordings (HR) on three consecutive days and baseline NT-pro BNP levels were determined. Patients were followed for occurrence of ventricular tachyarrhythmias or unexplained syncope. A great degree of variability was found regarding the occurrence of NSVTs (10% had NSVTs in two consecutive HR, 10% in three consecutive HR, 30% in one HR and 50% had no NSVTs). Patients with NSVTs in more than one HR had significantly higher NT-pro BNP levels (first quartile: 715 pg/ml, median 2,176 pg/ml, third quartile 5,755 pg/ml vs. first quartile 273 pg/ml, median 566 pg/ml, third quartile 1,350 pg/ml, P = 0.0388). During a mean follow-up of 21.6 +/- 1.2 months patients with an arrhythmic event had significantly higher NT-pro BNP levels than patients without event (first quartile: 1,002 pg/ml, median 4,075 pg/ml, third quartile 7,777 pg/ml vs. first quartile 173 pg/ml, median 267 pg/ml, third quartile 1,220 pg/ml, P = 0.0135). NT-pro BNP levels of 2,259 pg/ml were identified as optimal cut-off value for the prediction of arrhythmic events (P = 0.0313). In contrast reproducible NSVTs were not predictive for arrhythmic events (P = 0.0960).
The present study demonstrates that in patients with DCM the value of reproducible NSVTs in predicting arrhythmic events is low. In contrast raised NT-pro BNP levels significantly correlated with occurrence of symptomatic ventricular arrhythmias. Larger prospective trials are required to confirm these results.
非缺血性心肌病（扩张型心肌病，DCM）患者发生心源性猝死（SCD）的风险很高。然而，对于这一患者群体，预防性植入植入式心脏复律除颤器（ICD）的预测价值尚不清楚。
前瞻性地检测了30例左室射血分数（LVEF）≤40%的DCM患者中，N末端B型利钠肽原（NT pro BNP）水平和/或可重复性非持续性室性心动过速（NSVT）对SCD的预测价值。所有患者连续三天接受动态心电图记录（HR），并测定基线NT-pro BNP水平。对患者进行随访，观察是否发生室性心律失常或不明原因的晕厥。发现NSVT的发生存在很大差异（10%的患者在连续两次HR中有NSVT，10%在连续三次HR中有NSVT，30%在一次HR中有NSVT，50%没有NSVT）。在不止一次HR中有NSVT的患者NT-pro BNP水平显著更高（第一四分位数：715 pg/ml，中位数2176 pg/ml，第三四分位数5755 pg/ml，对比第一四分位数273 pg/ml，中位数566 pg/ml，第三四分位数1350 pg/ml，P = 0.0388）。在平均21.6±1.2个月的随访期间，发生心律失常事件的患者NT-pro BNP水平显著高于未发生事件的患者（第一四分位数：1002 pg/ml，中位数4075 pg/ml，第三四分位数7777 pg/ml，对比第一四分位数173 pg/ml，中位数267 pg/ml，第三四分位数1220 pg/ml，P = 0.0135）。NT-pro BNP水平2259 pg/ml被确定为预测心律失常事件的最佳临界值（P = 0.0313）。相比之下，可重复性NSVT对心律失常事件没有预测价值（P = 0.0960）。
本研究表明，在DCM患者中，可重复性NSVT对心律失常事件的预测价值较低。相比之下，升高的NT-pro BNP水平与有症状的室性心律失常的发生显著相关。需要更大规模的前瞻性试验来证实这些结果。
