N‐terminal pro‐B‐type natriuretic peptide for prediction of ventricular arrhythmias: Data from the SMASH study

Background Elevated N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) concentrations predict heart failure (HF) and mortality, but whether NT‐proBNP predicts ventricular arrhythmias (VA) is not clear. Hypothesis We hypothesize that high NT‐proBNP concentrations associate with the risk of incident VA, defined as adjudicated ventricular fibrillation or sustained ventricular tachycardia. Methods In a prospective, observational study of patients treated with implantable cardioverter defibrillator (ICD), we analyzed NT‐proBNP concentrations at baseline and after mean 1.4 years in association to incident VA. Results We included 490 patients (age 66 ± 12 years, 83% men) out of whom 51% had a primary prevention ICD indication. The median NT‐proBNP concentration was 567 (25–75 percentile 203–1480) ng/L and patients with higher concentrations were older with more HF and ICD for primary prevention. During mean 3.1 ± 0.7 years, 137 patients (28%) had ≥1 VA. Baseline NT‐proBNP concentrations were associated with the risk of incident VA (hazard ratio [HR]: 1.39, 95% confidence interval [95% CI]: 1.22–1.58, p