PROGNOSTIC VALUE OF NATRIURETIC PEPTIDES IN RISK ASSESSMENT OF VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH HEART FAILURE AND ATRIAL FIBRILLATION

Background. Increased levels of brain natriuretic peptide (BNP) and the N-terminal fragment of brain natriuretic peptide (NT-proBNP) in heart failure (HF) indicates atrial and ventricular myocardial remodeling. BNP and NT- proBNP have great prognostic value in patients with HF. However, atrial fibrillation (AF) can affect the interpretation of BNP and NT-proBNP. AF is one of the most common conditions in patients with HF and assessing the predictive value of BNP and NT-proBNP is extremely important in clinical practice for patients with HF and AF. Aim. To determine ventricular arrhythmias (VA) markers in patients with HF and AF. To estimate the predictive significance of BNP and NT-proBNP in the VA risk assessment in patients with HF and AF. Material and methods. Totally, 164 HF patients with left ventricular ejection fraction (LVEF <50%) were included into the study. All the patients underwent transthoracic echocardiography using standard echocardiographic positions; 24-hour ECG monitoring to assess types and nature of VA. BNP and NT-proBNP levels were determined by enzyme immunoassay (ELISA) in venous blood plasma. Results. In the group of patients with HF and AF paroxysms of non-sustained ventricular tachycardia (NSVT) were more frequently recorded compared to the patients with sinus rhythm (48 (52.2%) versus 21 (29.2%); p=0.005). Patients with HF and AF with NSVT compared with patients without NSVT have larger left atrial and left ventricular (LV) sizes and LV volumes; differences between LVEF being without statistical significance of the results. Patients with HF, AF and NSVT, compared with patients without NSVT, have significantly higher levels of BNP (298.8 [149; 500.6] pg/mL versus 152 [145.7; 335.4] pg/mL, p=0.02) and NT-proBNP (2071.5 [1385; 4652.4] pg/mL vs. 971 [778.5; 1452] pg/mL, p<0.0001). A significant positive correlation was found between the level of BNP and the amount of NSVT per day; there is a positive correlation between the level of NT-proBNP and the amount of NSVT per day. Conclusion. The incidence of NSVT among patients with HF and AF is higher compared with patients with HF and sinus rhythm. Patients with HF and AF with registered NSVT are characterized by larger LA and LV sizes and LV volumes compared to patients without NSVT. Increased concentrations of BNP and NT-proBNP have a prognostic value in risk assessment of VA in patients with HF and AF.