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Raised B-type natriuretic peptide predicts implantable cardioverter-defibrillator therapy in patients with ischaemic cardiomyopathy
  1. R Klingenberg1,
  2. C Zugck1,
  3. R Becker1,
  4. D Schellberg1,
  5. G Heinze2,
  6. R Kell1,
  7. A Remppis1,
  8. W Schoels1,
  9. H A Katus1,
  10. T J Dengler1
  1. 1Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
  2. 2Section of Clinical Biometrics, Core Unit of Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria
  1. Correspondence to:
    Dr Roland Klingenberg
    Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany; rklingenberg{at}gmx.de

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Identification of patients with congestive heart failure (CHF) at risk for sudden cardiac death (SCD) remains a major problem. Implantable cardioverter-defibrillator (ICD) implantation constitutes an effective preventive strategy, both for primary and for secondary prevention of SCD.1,2 Evidence regarding the benefit of ICD implantation in patients with advanced CHF is limited, however, as death caused by pump failure becomes more important in these patients and the projected life span is short. Improved risk stratification for identification of appropriate candidates for ICD implantation appears critical to ensure access of eligible patients to this lifesaving treatment and to spare inappropriate candidates the side effects. Cost effectiveness is critically dependent on identification of appropriate high-risk subgroups in patient groups with low left ventricular ejection fraction (LVEF).1 The role of the B-type natriuretic peptides in predicting mortality in patients with CHF including SCD is increasingly being recognised.3,4 The definition of SCD used in clinical trials does not rule out ischaemic or non-cardiac causes of death, however, as shown by an autopsy study.5 The present study evaluated the hypothesis that raised N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations may predict ventricular tachyarrhythmia as a surrogate marker of SCD in patients with ischaemic CHF and an ICD device.

METHODS

NT-proBNP concentrations (Roche Diagnostics, Mannheim, Germany) were determined at ICD implantation in patients with ischaemic CHF (scintigraphic LVEF ⩽ 30%) and were correlated with the results of ICD interrogation during the first postoperative year. Exclusion criteria were NT-proBNP measurement unavailable …

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