Key result
Serial measurements of BNP and ST2 at 3-month intervals over 1 year did not improve risk stratification for ventricular arrhythmias or death compared to baseline-only measurements.
Why the study?
Markers of inflammation and heart failure are linked to ventricular arrhythmias and death, but biomarker levels and risk may vary over time.
Does serial measurement of inflammatory biomarkers and BNP improve risk stratification for ventricular arrhythmias and death compared to baseline measurement alone in ambulatory patients with LVEF ≤35% and an ICD?
Cohort (n=196)
Does serial measurement of inflammatory biomarkers and BNP improve risk stratification for ventricular arrhythmias and death compared to baseline measurement alone in ambulatory patients with LVEF ≤35% and an ICD?
In stable ambulatory patients with systolic cardiomyopathy and an ICD, repeated laboratory measurements of BNP and ST2 over a year do not improve risk stratification for ventricular tachyarrhythmia or death beyond baseline measurement alone.
Serial BNP/ST2 measurements add no risk-stratification benefit beyond baseline in systolic HF with ICD; leaves open utility of dynamic monitoring in other settings.
AIMS: Evidence links markers of systemic inflammation and heart failure (HF) with ventricular arrhythmias (VA) and/or death. Biomarker levels, and the risk they indicate, may vary over time. We evaluated the utility of serial laboratory measurements of inflammatory biomarkers and HF, using time-dependent analysis. METHODS AND RESULTS: We prospectively enrolled ambulatory patients with left ventricular ejection fraction (LVEF) ≤35% and a primary-prevention implanted cardioverter-defibrillator (ICD). Levels of established inflammatory biomarkers [C-reactive protein, erythrocyte sedimentation rate (ESR), suppression of tumourigenicity 2 (ST2), tumour necrosis factor alpha (TNF-α)] and brain natriuretic peptide (BNP) were assessed at 3-month intervals for 1 year. We assessed relationships between biomarkers modelled as time-dependent variables, VA, and death. Among 196 patients (66±14 years, LVEF 23±8%), 33 experienced VA, and 18 died. Using only baseline values, BNP predicted VA, and both BNP and ST2 predicted death. Using serial measurements at 3-month intervals, time-varying BNP independently predicted VA, and time-varying ST2 independently predicted death. C-statistic analysis revealed no significant benefit to repeated testing compared with baseline-only measurement. C-reactive protein, ESR, and TNF-α, either at baseline or over time, did not predict either endpoint. CONCLUSION: In stable ambulatory patients with systolic cardiomyopathy and an ICD, BNP predicts ventricular tachyarrhythmia, and ST2 predicts death. Repeated laboratory measurements over a year's time do not improve risk stratification beyond baseline measurement alone. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT01892462 (https://clinicaltrials.gov/ct2/show/NCT01892462).
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Morin et al. (2020) conducted a cohort in Systolic cardiomyopathy (n=196). Serial measurement of biomarkers (BNP, ST2, CRP, ESR, TNF-α) vs. Baseline-only measurement was evaluated on Ventricular arrhythmias and death. Serial measurements of BNP and ST2 at 3-month intervals over 1 year did not improve risk stratification for ventricular arrhythmias or death compared to baseline-only measurements.
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