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Defining potential to benefit from implantable cardioverter defibrillator therapy: the role of biomarkers

Defining potential to benefit from implantable cardioverter defibrillator therapy: the role of biomarkers
Defining potential to benefit from implantable cardioverter defibrillator therapy: the role of biomarkers
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.
implantable cardioverter defibrillators, heart failure, biomarkers, mortality, arrhythmias
1099-5129
1419-1427
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Townsend, Paul A.
a2680443-664e-46d0-b4dd-97456ba810db
Ng, Leong L.
7c95e856-3d42-42b5-9f3d-467efa7145c2
Zeb, Mehmood
469fda8e-8318-4fe5-97f3-a46eec60f333
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Scott, Paul A.
5a16b1f4-74d3-473f-9eeb-c2a823d690dc
Townsend, Paul A.
a2680443-664e-46d0-b4dd-97456ba810db
Ng, Leong L.
7c95e856-3d42-42b5-9f3d-467efa7145c2
Zeb, Mehmood
469fda8e-8318-4fe5-97f3-a46eec60f333
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Roderick, Paul J.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Curzen, Nick P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680

Scott, Paul A., Townsend, Paul A., Ng, Leong L., Zeb, Mehmood, Harris, Scott, Roderick, Paul J., Curzen, Nick P. and Morgan, John M. (2011) Defining potential to benefit from implantable cardioverter defibrillator therapy: the role of biomarkers. Europace, 13 (10), 1419-1427. (doi:10.1093/europace/eur147). (PMID:21784745)

Record type: Article

Abstract

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.

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More information

Accepted/In Press date: 21 July 2011
Published date: October 2011
Keywords: implantable cardioverter defibrillators, heart failure, biomarkers, mortality, arrhythmias
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 194395
URI: http://eprints.soton.ac.uk/id/eprint/194395
ISSN: 1099-5129
PURE UUID: ab29c864-c4dd-4e81-a30e-3f8a9f1b6f90
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Nick P. Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 27 Jul 2011 12:58
Last modified: 15 Mar 2024 03:23

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Contributors

Author: Paul A. Scott
Author: Paul A. Townsend
Author: Leong L. Ng
Author: Mehmood Zeb
Author: Scott Harris
Author: Nick P. Curzen ORCID iD
Author: John M. Morgan

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