LGE and NT-proBNP identify low risk of death or arrhythmic events in patients with primary prevention ICDs

Mordi, I., Jhund, P. S. , Gardner, R. S., Payne, J., Carrick, D., Berry, C. and Tzemos, N. (2014) LGE and NT-proBNP identify low risk of death or arrhythmic events in patients with primary prevention ICDs. JACC: Cardiovascular Imaging, 7(6), pp. 561-569. (doi:10.1016/j.jcmg.2013.12.014)

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Publisher's URL: http://dx.doi.org/10.1016/j.jcmg.2013.12.014

Abstract

Objectives

The aim of this study was to investigate whether late gadolinium enhancement (LGE) magnetic resonance imaging or N-terminal pro–B-type natriuretic peptide (NT-proBNP) could identify patients with a low risk of death or use of implantable cardioverter-defibrillator (ICD) in patients receiving a primary prevention ICD.

Background

ICDs reduce mortality in patients with heart failure (HF), although two-thirds may never use their device. Current risk stratification, based on New York Heart Association functional class and left ventricular ejection fraction, still leads to implantation of ICDs in patients who may never need their device.

Methods

We examined 157 patients with HF (61 with ischemic cardiomyopathy and 96 with dilated cardiomyopathy; mean age 50.5 years; 78% male) who underwent primary prevention defibrillator implantation. Presence and volume of LGE was measured before device implantation, and serum NT-proBNP level was measured before ICD implantation. The combined primary endpoint was cardiovascular death or appropriate ICD therapy (either appropriate shock or antitachycardia pacing).

Results

The primary outcome occurred in 32 patients (20.4%) over a median follow-up period of 915 days. Percentage of LGE (hazard ratio [HR]: per 1% increase: 1.06; 95% confidence interval [CI]: 1.04 to 1.09; p < 0.001) and (ln) NT-proBNP (HR: 1.44; 95% CI: 1.04 to 1.98; p = 0.027) were predictors of death or appropriate ICD activation and remained significant when entered into multivariable analysis. When the cohort was stratified into tertiles based on LGE percentage and NT-proBNP, we were able to identify a low-risk group (event rate 3% per year, compared with the intermediate- and high-risk groups [6% and 10% per year, respectively]).

Conclusions

Both percentage of LGE and NT-proBNP were associated with higher risk of death or appropriate ICD activation. The use of these markers in combination may be useful in identifying individuals most likely to benefit from this costly intervention, and more specifically, in the identification of a group at lower risk in whom ICD implantation may be deferred.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Carrick, Dr David and Gardner, Dr Roy and Tzemos, Dr Nikolaos and Berry, Professor Colin and Jhund, Dr Pardeep and Mordi, Dr Ify
Authors: Mordi, I., Jhund, P. S., Gardner, R. S., Payne, J., Carrick, D., Berry, C., and Tzemos, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:JACC: Cardiovascular Imaging
Publisher:Elsevier Inc.
ISSN:1936-878X
ISSN (Online):1876-7591

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