Abstract

BACKGROUND: Elevated γ-glutamyltransferase (GGT) is a new risk factor for cardiovascular diseases, but its impact on ventricular tachyarrhythmia occurrence and survival in patients with an implantable cardioverter defibrillator (ICD) is unknown. METHODS AND RESULTS: Considering that GGT levels are gender-dependent, female ICD recipients were excluded from our database because of the low incidence of events. In a retrospective analysis, appropriate ICD therapy (both shocks and antitachycardia pacing due to ventricular tachyarrhythmias) occurred in 31.9% of 320 male patients who had received an ICD for primary prevention (median follow-up of 2.3 years), and in 55.1% of 423 male patients who had received an ICD for secondary prevention (median follow-up of 3.9 years). Compared to normal low GGT plasma levels (below 28 U/L), total mortality but not risk for appropriate ICD therapy was elevated for higher GGT categories (p for trend = 0.004 in primary prevention and p for trend = 0.002 in secondary prevention, respectively). In Cox regression analysis, elevated GGT (>56 U/L) remained an independent predictor of death both in primary (p = 0.011) and in secondary prevention (p = 0.006). Patients with elevated GGT and renal insufficiency defined by an estimated glomerular filtration rate <60 ml/min/1.73 m(2) suffered from excess total mortality jeopardizing the benefit of ICD therapy. CONCLUSION: Elevation of GGT is an important adverse prognostic parameter in ICD patients. A possible role of GGT for improved patient selection for ICD therapy deserves further investigation.