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N-terminal pro–B-type natriuretic peptide is a specific predictor of appropriate device therapies in patients with primary prevention implantable cardioverter-defibrillators

  • Author Footnotes
    1 Dr Sroubek’s current location is Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
    Jakub Sroubek
    Footnotes
    1 Dr Sroubek’s current location is Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
    Affiliations
    Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Jason Matos
    Affiliations
    Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Andrew Locke
    Affiliations
    Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Vladimir Kaplinskiy
    Affiliations
    Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Yehoshua C. Levine
    Affiliations
    University of Tennessee Health Sciences Center, Memphis, Tennessee

    Methodist le Bonheur Healthcare, Memphis, Tennessee
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  • Changyu Shen
    Affiliations
    Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Alfred E. Buxton
    Correspondence
    Address reprint requests and correspondence: Dr Alfred E. Buxton, Cardiovascular Division, Beth Israel Deaconess Medical Center, Baker 4, 185 Pilgrim Rd, Boston, MA 02215.
    Affiliations
    Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Author Footnotes
    1 Dr Sroubek’s current location is Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Published:August 28, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.08.014

      Background

      Sudden death risk stratification of patients with left ventricular systolic dysfunction remains challenging. Retrospective studies have suggested N-terminal pro–B-type natriuretic peptide (NT-proBNP) may be a useful risk stratification tool.

      Objective

      The purpose of this study was to ascertain the utility of NT-proBNP as a predictor of appropriate implantable cardioverter-defibrillator (ICD) therapies in primary prevention ICD recipients.

      Methods

      This was a prospective study of 342 stable patients with left ventricular ejection fraction ≤40% who received a primary prevention ICD. NT-proBNP assay was performed at the time of device implant and used as a dichotomized variable (1st–3rd NT-proBNP quartiles vs 4th NT-proBNP quartile) to predict primary (appropriate ICD therapies) and secondary (death, ICD-deactivation, chronic inotropic support, transplant) outcomes.

      Results

      Median follow-up was 35.0 months (interquartile range 15.2–55.3). In unadjusted analyses, NT-proBNP predicted both primary (hazard ratio [HR] 1.89; 95% confidence interval [CI] 1.00–3.56); P = .049) and secondary outcomes (HR 2.13; 95% CI 1.18–3.85; P =.012). Multivariable analysis reaffirmed NT-proBNP as a primary outcome predictor (HR 4.31; 95% CI 1.92–9.70; P <.001) but not as a secondary outcome predictor (HR 1.23; 95% CI 0.61–2.50; P = .564). Instead, secondary outcome was predicted by patient age and renal function. In an unadjusted subanalysis limited to patients with blood urea nitrogen <30 mg/dL, NT-proBNP remained a primary endpoint predictor (HR 2.51; 95% CI 1.25–5.05; P = .010) but not a secondary endpoint predictor (HR 1.34; 95% CI 0.52–3.44; P = .541). Receiver operating analyses at 2- and 3-year follow-up timepoints confirmed that NT-proBNP significantly improved the performance of multivariable models designed to predict future appropriate ICD therapies.

      Conclusion

      In multivariable analysis, NT-proBNP is a reasonable and specific predictor of future appropriate device therapies in primary prevention ICD recipients. In contrast, adjusted NT-proBNP does not predict all-cause mortality.

      Keywords

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