Heart rate turbulence and brain natriuretic peptide level as predictors for life-threatening arrhythmias in patients with coronary artery disease

Authors: E.Z. Golukhova, O.I. Gromova, V.Yu. Merzlyakov, K.V. Shumkov, L.A. Bockeria.

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences


For citation: Golukhova EZ, Gromova OI, Merzlyakov VYu, at al. Heart rate turbulence and brain natriuretic peptide level as predictors for life-threatening arrhythmias in patients with coronary artery disease. Kreativnaya kardiologiya. 2013; 2: 62-77 (in Russian).

Keywords: malignant arrhythmias sudden cardiac death primary prevention heart rate turbulence brain natriuretic peptide implantable cardioverter defibrillators

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Abstract

Objective. Aim of our investigation was: to estimate prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with coronary artery disease in long-term follow-up.

Material and methods. We prospectively enrolled 97 patients with coronary artery disease (confirmed by coronary angiography) at the mean age of 61±10 years. Most of patients (68%) had a New York Heart Association (NYHA) functional class of 0–II. The mean left ventricular ejection fraction (LVEF) was 50±13%; 20% of patients had LVEF ≤ 35%. Sixty patients had revascularization procedures during follow-up. We calculated following noninvasive electrophysiological markers as part of 24-hour Holter monitoring: microvolt T-wave alternans, signal-averaged electrocardiography, QT-interval duration and dynamics, heart rate turbulence and variability. Laboratory tests included: serum creatine and creatine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels.

Results. Life-threatening ventricular arrhythmias were observed in 11 (11%) patients during mean follow-up period of 25±11 months. Intraoperative malignant ventricular arrhythmias developed in 8 (13%) patients of 60 operated ones. On univariate analysis, past angioplasty (P<0.05), past malignant arrhythmias or syncope (P<0.05), LVEF ≤ 47% (P<0.01), left atrium size ≥ 4.7 cm (P<0.05), left atrium index (P=0.01), filtered QRS duration (P<0.05), abnormal heart rate turbulence (HRT) (χ2 test=6.2, P=0.01), abnormal turbulence slope (χ2 test=9.5, P<0.01), BNP ≥ 158 pg/ml (P<0.01), NT-proBNP ≥ 787 pg/ml (χ2 test=4.4, P<0.05) were significantly associated with malignant arrhythmias in long-term follow-up. Past malignant arrhythmias or syncope (OR [95% CI] 0.04: 0.05–0.28; P<0.01), abnormal HRT (ОR [95% CI] 19.9: 2.2–178.7; P<0.01), and plasma BNP ≥ 158 pg/ml (ОR [95% CI] 18.5: 2.9–116.8; P<0.01) were independent predictors for the first endpoint on multivariate Cox regression analysis. Predictors for VF/VT during revascularization or early postoperative period on univariate analysis were: multivessel coronary stenosis (P<0.01) and left main coronary artery lesion (P<0.01).

Conclusion. Heart rate turbulence and plasma brain natriuretic peptide level could be additional noninvasive markers of life-threatening arrhythmias improving primary prevention of sudden cardiac death approach.

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery