Levine Yehoshua C, Rosenberg Michael A, Mittleman Murray, Samuel Michelle, Methachittiphan Nilubon, Link Mark, Josephson Mark E, Buxton Alfred E
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
VA Boston Healthcare System, Boston, Massachusetts.
Heart Rhythm. 2014 Jul;11(7):1109-16. doi: 10.1016/j.hrthm.2014.04.024. Epub 2014 May 13.
The cost-effective use of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death requires identification of patients at risk for ventricular tachyarrhythmias, not just for total mortality.
To determine whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) or B-type natriuretic peptide (BNP) are independent predictors of ventricular arrhythmias in patients receiving primary prevention ICDs.
One hundred sixty-one patients with NT-proBNP levels and 403 patients with BNP levels at the time of ICD implantation were retrospectively assessed for the occurrence of first appropriate ICD therapy and mortality.
In multivariable Cox proportional hazards regression analysis, NT-proBNP or BNP levels in the upper 50th percentile were the strongest predictor of ICD therapy after adjustment for sex, age, left ventricular ejection fraction, New York Heart Association class, history of coronary artery disease, blood urea nitrogen, creatinine clearance, and history of atrial fibrillation (hazard ratio [HR] 5.75, P < .001 for NT-proBNP; HR 3.40, P = .01 for BNP). Patients were divided into quartiles on the basis of NT-proBNP or BNP levels. The adjusted HR for ICD therapy in the highest and second highest quartiles of NT-proBNP levels (HR 12.9, P < .001, and HR 4.6, P = .03, respectively) were higher than the adjusted HR for total mortality in these 2 quartiles (HR 3.4, P = .021 and HR 2.3, P = .13, respectively). Similarly, the adjusted HR for ICD therapy in the highest and second highest quartiles of BNP levels (HR 4.74, P = .01 and HR 2.17, P = .04, respectively) were higher than the adjusted HR for total mortality in these 2 quartiles (HR 3.05, P = .01 and HR 1.07, P = .3, respectively).
In this study, elevated baseline NT-proBNP and BNP levels are independently associated with the risk for ventricular tachyarrhythmias, which significantly exceeds the risk for total mortality, in multivariable analysis.
为预防心脏性猝死而经济高效地使用植入式心律转复除颤器（ICD），需要识别有室性快速心律失常风险的患者，而非仅关注总死亡率。
确定N末端B型利钠肽原（NT-proBNP）或B型利钠肽（BNP）是否为接受一级预防ICD的患者发生室性心律失常的独立预测因素。
回顾性评估161例植入ICD时检测NT-proBNP水平的患者以及403例检测BNP水平的患者首次接受适当ICD治疗和死亡情况。
在多变量Cox比例风险回归分析中，在校正性别、年龄、左心室射血分数、纽约心脏协会心功能分级、冠状动脉疾病史、血尿素氮、肌酐清除率和心房颤动史后，NT-proBNP或BNP水平处于上50%百分位数是ICD治疗的最强预测因素（NT-proBNP的风险比[HR]为5.75，P <.001；BNP的HR为3.40，P =.01）。根据NT-proBNP或BNP水平将患者分为四分位数。NT-proBNP水平最高和次高四分位数中ICD治疗的校正HR（分别为HR = 12.9，P <.001和HR = 4.6，P =.03）高于这两个四分位数中总死亡率的校正HR（分别为HR = 3.4，P =.021和HR = 2.3，P =.13）。同样，BNP水平最高和次高四分位数中ICD治疗的校正HR（分别为HR = 4.74，P =.01和HR = 2.17，P =.04）高于这两个四分位数中总死亡率的校正HR（分别为HR = 3.05，P =.01和HR = 1.07，P =.3）。
在本研究中，多变量分析显示，基线NT-proBNP和BNP水平升高与室性快速心律失常风险独立相关，且该风险显著超过总死亡率风险。
