Defining potential to benefit from implantable cardioverter defibrillator therapy: the role of biomarkers
| Autor: | Paul A. Scott, Leong L. Ng, Scott Harris, Mehmood Zeb, Paul A. Townsend, John M. Morgan, Nick Curzen, Paul Roderick |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Growth Differentiation Factor 15 medicine.drug_class medicine.medical_treatment Pilot Projects Receptors Cell Surface Kaplan-Meier Estimate Sudden cardiac death Cohort Studies Predictive Value of Tests Risk Factors Physiology (medical) Internal medicine Natriuretic Peptide Brain medicine Natriuretic peptide Humans Prospective Studies Prospective cohort study Aged Interleukin-6 Proportional hazards model business.industry Absolute risk reduction Middle Aged medicine.disease Implantable cardioverter-defibrillator Interleukin-1 Receptor-Like 1 Protein Peptide Fragments Defibrillators Implantable C-Reactive Protein Death Sudden Cardiac Treatment Outcome Heart failure Etiology Cardiology Female Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | Europace. 13:1419-1427 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/eur147 |
| Popis: | Aims 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. Methods and results 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). Conclusion 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. |
| Databáze: | OpenAIRE |
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