Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK.
Europace. 2011 Oct;13(10):1419-27. doi: 10.1093/europace/eur147. Epub 2011 Jul 21.
Implantable cardioverter defibrillator (ICD) therapy improves survival in patients at high sudden cardiac death (SCD) risk. However, some patient groups fulfilling indications for ICD therapy may not gain significant benefit: patients whose absolute risk of SCD is low and patients whose risk of death even with an ICD is high. The value of biomarkers in identifying patients' potential for survival benefit from ICD therapy is unknown. We performed a pilot study to investigate this.
Five established cardiovascular biomarkers were measured in patients with ICDs on the background of left ventricular dysfunction: N-terminal pro-brain natriuretic peptide [NT-proBNP], soluble ST2 [sST2], growth differentiation factor-15, C-reactive protein, and interleukin-6. The endpoints were all-cause mortality and survival with appropriate ICD therapy. One hundred and fifty-six patients were enrolled (age 69 years [Q1-Q3 62-77], 85% male, 76% ischaemic aetiology). During a follow-up of 15 ± 3 months, 12 patients died and 43 survived with appropriate ICD therapy. In a Cox proportional hazards model, the strongest predictors of death were Log sST2 (P< 0.001), serum creatinine (P< 0.001), and Log NT-proBNP (P= 0.002). The strongest predictor of survival with appropriate ICD therapy was Log NT-proBNP (P= 0.01).
The biomarkers NT-proBNP and sST2 are promising biomarkers for identifying patients with little potential to gain significant survival benefit from ICD therapy. However, their incremental benefit, in addition to currently available clinical risk prediction models, remains unclear. These results demand a confirmatory prospective cohort study, designed and powered to derive and validate prediction algorithms incorporating these markers.
植入式心脏复律除颤器（ICD）治疗可提高高危心源性猝死（SCD）患者的生存率。然而，一些符合 ICD 治疗适应证的患者群体可能无法获得显著获益：SCD 绝对风险较低的患者和即使植入 ICD 风险也较高的患者。生物标志物在确定患者从 ICD 治疗中获益的生存潜力方面的价值尚不清楚。我们进行了一项试点研究来对此进行调查。
在左心室功能障碍背景下，对植入 ICD 的患者测量了 5 种已确立的心血管生物标志物：氨基末端脑利钠肽前体[NT-proBNP]、可溶性 ST2[sST2]、生长分化因子-15、C 反应蛋白和白细胞介素-6。终点是全因死亡率和适当 ICD 治疗后的生存率。共纳入 156 例患者（年龄 69 岁[Q1-Q3 62-77]，85%为男性，76%为缺血性病因）。在 15±3 个月的随访期间，12 例患者死亡，43 例患者适当 ICD 治疗后存活。在 Cox 比例风险模型中，死亡的最强预测因素是 Log sST2（P<0.001）、血清肌酐（P<0.001）和 Log NT-proBNP（P=0.002）。适当 ICD 治疗后生存的最强预测因素是 Log NT-proBNP（P=0.01）。
生物标志物 NT-proBNP 和 sST2 是有前途的生物标志物，可用于识别从 ICD 治疗中获益生存获益不大的患者。然而，除了目前可用的临床风险预测模型外，它们的附加获益尚不清楚。这些结果需要进行一项设计并具有验证预测算法能力的前瞻性队列研究，该算法包含这些标志物。
