TY - JOUR T1 - Role of N-terminal pro-B type natriuretic peptide as a predictor of poor outcomes in patients with HFrEF receiving primary prevention implantable cardioverter-defibrillator therapy: a systematic review and dose–response meta-analysis JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2022-002225 VL - 10 IS - 1 SP - e002225 AU - Hawani Sasmaya Prameswari AU - Iwan Cahyo Santosa Putra AU - William Kamarullah AU - Raymond Pranata AU - Mohammad Iqbal AU - Giky Karwiky AU - Miftah Pramudyo AU - Nuraini Yasmin Kusumawardhani AU - Chaerul Achmad AU - Januar Wibawa Martha AU - Mohammad Rizki Akbar Y1 - 2023/03/01 UR - http://openheart.bmj.com/content/10/1/e002225.abstract N2 - Introduction Several studies have demonstrated that combining left ventricular ejection fraction and New York Heart Association functional class is insufficient for predicting risk of appropriate implantable cardioverter-defibrillator (ICD) shock in primary prevention candidates. Hence, our aim was to assess the relationship between N-terminal pro-B type natriuretic peptide (NT-pro BNP) along with appropriate ICD shock and all-cause mortality in order to improve the stratification process of patients with heart failure with reduced ejection fraction (HFrEF) being considered for primary preventive ICD therapy.Methods A systematic literature search from several databases was conducted up until 9 June 2022. Studies were eligible if they investigated the relationship of NT-pro BNP with all-cause mortality and appropriate ICD shock.Results This meta-analysis comprised nine studies with a total of 5117 participants. Our study revealed that high levels of NT-pro BNP were associated with all-cause mortality (HR=2.12 (95% CI=1.53 to 2.93); p<0.001, I2=78.1%, p<0.001 for heterogeneity) and appropriate ICD shock (HR=1.71 (95% CI=1.18 to 2.49); p<0.001, I2=43.4%, p=0.102 for heterogeneity). The adjusted HR for all-cause mortality and appropriate ICD shock increased by approximately 3% and 5%, respectively per 100 pg/mL increment pursuant to concentration–response model (Pnon-linearity <0.001). The curves became steeper after NT-pro BNP reached its inflection point (3000 pg/mL).Conclusion A positive concentration-dependent association between elevated NT-pro BNP levels along with the risk of all-cause mortality and appropriate ICD shock was found in patients with HFrEF with ICD.PROSPERO registration number CRD42022339285.Data are available upon reasonable request. ER -