• Alan Cheng, Yiyi Zhang, Elena Blasco-Colmenares, Darshan Dalal, Barbara Butcher, Sanaz Norgard, Zayd Eldadah, Kenneth A Ellenbogen, Timm Dickfeld, David D Spragg, Joseph E Marine, Eliseo Guallar, and Gordon F Tomaselli.
• From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.).
• Circ Arrhythm Electrophysiol. 2014 Dec 1; 7 (6): 1084-91.

BackgroundPrimary prevention implantable cardioverter defibrillators (ICDs) reduce all-cause mortality, but the benefits are heterogeneous. Current risk stratification based on left ventricular ejection fraction has limited discrimination power. We hypothesize that biomarkers for inflammation, neurohumoral activation, and cardiac injury can predict appropriate shocks and all-cause mortality in patients with primary prevention ICDs.Methods And ResultsThe Prospective Observational Study of Implantable Cardioverter Defibrillators (PROSe-ICD) enrolled 1189 patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end point was an ICD shock for adjudicated ventricular tachyarrhythmia. The secondary end point was all-cause mortality. After a median follow-up of 4.0 years, 137 subjects experienced an appropriate ICD shock and 343 participants died (incidence rates of 3.2 and 5.8 per 100 person-years, respectively). In multivariable-adjusted models, higher interleukin-6 levels increased the risk of appropriate ICD shocks. In contrast, C-reactive protein, interleukin-6, tumor necrosis factor-α receptor II, pro-brain natriuretic peptide (pro-BNP), and cardiac troponin T showed significant linear trends for increased risk of all-cause mortality across quartiles. A score combining these 5 biomarkers identified patients who were much more likely to die than to receive an appropriate shock from the ICD.ConclusionsAn increase in serum biomarkers of inflammation, neurohumoral activation, and myocardial injury increased the risk for death but poorly predicted the likelihood of an ICD shock. These findings highlight the potential importance of serum-based biomarkers in identifying patients who are unlikely to benefit from primary prevention ICDs.Clinical Trial Registration Urlclinicaltrials.gov; Unique Identifier: NCT00733590.© 2014 American Heart Association, Inc.

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