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

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. (PACE 2011;1–8)