Theuns Dominic A M J, Smith Tim, Szili-Torok Tamas, Muskens-Heemskerk Agnes, Janse Petter, Jordaens Luc
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Pacing Clin Electrophysiol. 2012 Mar;35(3):275-82. doi: 10.1111/j.1540-8159.2011.03289.x. Epub 2011 Dec 8.
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.
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.
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).
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.
高敏C反应蛋白（hs-CRP）和B型利钠肽（BNP）是心血管风险分层的有用生物标志物。关于hs-CRP和BNP血清水平的预后价值以及未来触发植入式心律转复除颤器（ICD）治疗的室性心律失常事件的数据较少。
共有100例符合ICD植入条件的患者纳入前瞻性队列研究。在ICD植入前一天和预定的随访就诊时获取hs-CRP和BNP的血清水平。为进行风险分析，根据hs-CRP血清水平以3 mg/L的临界值将研究队列分为两组。终点是在24个月随访期间由室性心律失常触发的适当ICD治疗。
20%的患者接受了适当的ICD治疗。接受适当ICD治疗的患者的hs-CRP基线血清中位数水平显著高于未接受适当ICD治疗的患者（5.33 mg/L对2.19 mg/L；P = 0.002）。随访期间hs-CRP和BNP的血清中位数水平情况相同（分别为5.43 mg/L对2.61 mg/L，P = 0.001；261.0 pg/mL对80.1 pg/mL，P = 0.01）。多变量分析表明，基线hs-CRP水平> 3 mg/L与适当的ICD治疗独立相关（比值比4.0，95%置信区间1.1 - 14.2；P = 0.03）。
植入前hs-CRP血清水平升高与适当ICD治疗风险增加独立相关。随访期间监测BNP水平升高有助于评估未来心律失常的风险。
