NT-proBNP is superior to novel plasma biomarkers for predicting adverse outcome in arrhythmogenic right ventricular cardiomyopathy

Abstract

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive disease leading to ventricular arrhythmias and heart failure. Determining optimal time for heart transplantation (HTx) is challenging and finding risk factors for disease progression is needed.

Objectives: The study aimed to identify predictors of end-stage heart failure and evaluate the role of biomarkers in predicting adverse outcomes in ARVC.

Patients and methods: Ninety-one patients with ARVC (59 males, mean [SD] age 47 [16] years) were included. Patients were interviewed for medical history, electrocardiography and echocardiography were performed, and plasma levels of selected biomarkers (sST2, Gal-3, MMP-2, MMP-9, NT-proBNP, hsTnT) were measured. Thereafter, subjects were followed for primary endpoint of death or HTx and major arrhythmic events (MAEs), defined as sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator intervention.

Results: During the median follow-up of 36.4 (29.8-41.2) months, 13 (14%) subjects reached primary endpoint, and 27 (30%) experienced MAE. Higher levels of sST2, MMP-2, NT-proBNP, and hsTnT were found in patients who achieved the endpoint. Three factors turned out to be independent predictors for death or HTx: higher NT-proBNP concentration (≥890.3 pg/ml), greater right ventricular end-diastolic area (≥39.0 cm2), and history of atrial tachycardia. None of the biomarkers predicted MAE.

Conclusions: NT-proBNP ≥890.3 pg/ml, right ventricular area ≥39.0 cm2, and history of atrial tachycardia are risk factors for death or HTx in ARVC. Higher levels of sST2, MMP-2, NT-proBNP, and hsTnT are associated with reaching the endpoint. Biomarkers had no value in predicting ventricular arrhythmias.