Europace Advance Access originally published online on May 24, 2007
Europace 2007 9(9):724-729; doi:10.1093/europace/eum102
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IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS
Serum BNP, hs-C-reactive protein, procollagen to assess the risk of ventricular tachycardia in ICD recipients after myocardial infarction
1 Département de Cardiologie, CHU de Nancy, Hôpital de Brabois, Rue du Morvan, 54511 Vandoeuvre-lès-Nancy, France; 2 Centre d'Investigations Cliniques INSERM-CHU, Nancy, France; 3 Laboratoire Central de Biochimie, CHU de Nancy, France; 4 Unité mixte UHP-INSERM U684, CHU de Nancy, France
Aims Ventricular arrhythmia is the main cause of sudden cardiac death. Intracardiac strain, myocardial and extracellular matrix remodelling, and subsequent myocardial fibrosis are involved in arrhythmia pathogenesis. The present study investigates the relationship between cardiac fibrosis [procollagen type I aminoterminal peptide (PINP), procollagen type III aminoterminal peptide (PIIINP), TIMP1, membrane metalloproteinase I], pressure overload [brain natriuretic peptide (BNP)] inflammation [high sensitivity (hs)-C-reactive protein] serum markers, and the incidence of ventricular tachycardia (VT) in implantable cardioverter–defibrillators (ICD) recipients.
Methods and results Serum markers were collected in 121 patients implanted for spontaneous sustained VT and a prior history of myocardial infarction. VT incidence was obtained during ICD interrogation. Over a 1 year period, 38 patients (31%) experienced at least 1 VT. In a multivariate analysis, a left ventricular ejection fraction <0.35 (OR = 2.19, 95%CI 1.00–4.79, P = 0.049), an increased serum BNP (OR = 3.75, 95%CI 1.46–9.67, P = 0.014), an increased hs-C-reactive protein (OR = 3.2, 95%CI 1.26–8.10, P = 0.006), an increased PINP (OR = 3.71, 95%CI 1.40–9.88, P = 0.009), and a decreased PIIINP (OR = 0.21, 95%CI 0.08–0.59, P = 0.003) were associated with a higher VT incidence.
Conclusion In coronary artery disease patients: (1) BNP is not only a marker of left ventricular dysfunction, but also a marker of VT; (2) combined ‘high PINP and low PIIINP’ is a strong VT marker; and 3) inflammatory process is involved in VT pathogenesis.
Key Words: Procollagen, BNP, C-reactive protein, Extracellular matrix, Ventricular tachycardia, Coronary artery disease
* Corresponding author. Tel: +33 3 83 15 42 82; fax: +33 3 83 85 43 82. E-mail address: h.blangy{at}chu-nancy.fr
Manuscript submitted 1 March 2007. Accepted after revision 21 April 2007.
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