Prognostic role of high-sensitivity C-reactive protein and B-type natriuretic peptide in implantable cardioverter-defibrillator patients

Pacing Clin Electrophysiol. 2012 Mar;35(3):275-82. doi: 10.1111/j.1540-8159.2011.03289.x. Epub 2011 Dec 8.

Abstract

Background: High-sensitivity C-reactive protein (hs-CRP) and B-type natriuretic peptide (BNP) are useful biomarkers for cardiovascular risk stratification. Little data are available regarding the prognostic value of hs-CRP and BNP serum levels and future ventricular arrhythmic events triggering implantable cardioverter defibrillator (ICD) therapy.

Methods: A total of 100 patients eligible for ICD implantation were enrolled in a prospective cohort study. Serum levels of hs-CRP and BNP were obtained the day before ICD implantation and at scheduled follow-up visits. For risk analysis, the study cohort was dichotomized based on serum level of hs-CRP using a cut-off value of 3 mg/L. The endpoint was appropriate ICD therapy triggered by ventricular arrhythmias during a follow-up of 24 months.

Results: Appropriate ICD therapy was delivered in 20% of patients. Median baseline serum level of hs-CRP was significantly higher in patients with appropriate ICD therapy than in those without appropriate ICD therapy (5.33 mg/L vs 2.19 mg/L; P = 0.002). The same was true for median serum levels of hs-CRP and BNP during follow-up (5.43 mg/L vs 2.61 mg/L, P = 0.001 and 261.0 pg/mL vs 80.1 pg/mL, P = 0.01, respectively). Multivariate analysis demonstrated that baseline hs-CRP level > 3 mg/L was independently associated with appropriate ICD therapy (odds ratio 4.0, 95% 1.1-14.2; P = 0.03).

Conclusion: Elevated preimplantation hs-CRP serum level is independently associated with increased risk for appropriate ICD therapy. Monitoring for elevated BNP levels during follow-up adds to the assessment of risk for future arrhythmias.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism*
  • Defibrillators, Implantable*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Prognosis
  • Risk
  • Tachycardia, Ventricular / blood*
  • Tachycardia, Ventricular / therapy*

Substances

  • Natriuretic Peptide, Brain
  • C-Reactive Protein