Prognostische Bedeutung von B-Typ natriuretischen Peptid-Plasmakonzentrationen bei Patienten mit chronischer Herzinsuffizienz und implantiertem Cardioverter/Defibrillator

We examined whether B-type natriuretic peptide (BNP) levels predict outcome in heart failure patients with implantable cardioverter defibrillators (ICD) using a combined endpoint of malignant tachyarrhythmias, death or heart transplantation. BNP levels were measured in 123 ICD patients with chronic heart failure (age: 63±12 years, ejection fraction: 29±10%). After a median follow-up of 25 months, the combined endpoint was reached in 28 patients (first tachyarrhythmic event, n=16; death, n=11; heart transplantation, n=1). BNP levels were significantly lower in patients with event-free survival compared to patients reaching the combined endpoint of this study (median: 140 vs. 373 pg/ml; pb0.001). Multivariable Cox regression analysis revealed that BNP levels predict adverse outcome (RR 1.002 per pg/ml increment; 95% CI: 1.001–1.003; pb0.001) and use of beta-blockers was associated with favourable outcome (RR 0.319; 95% CI 0.151–0.670; p=0.004). LV ejection fraction ( p=0.66) did not significantly predict event-free survival in multivariable analysis. BNP plasma levels are useful markers to predict event-free survival in ICD patients with heart failure. Of note, malignant tachyarrhythmias appear responsible for about 50% of fatal outcomes. Our findings suggest that determination of BNP plasma levels is more valuable than determining LV ejection fraction to anticipate event-free survival in this population.