title: Prognostic value of brain natriuretic peptide in the management of patients receiving cardiac resynchronization therapy.
abstract: OBJECTIVE
  To evaluate the role of brain natriuretic peptide (BNP) in predicting the progression of heart failure (HF) after cardiac resynchronization therapy (CRT).
  
  
  BACKGROUND
  It has been shown that BNP predicts the prognosis and can guide the treatment of HF.
  
  
  METHODS
  We studied 50 consecutive patients (61+/-10 years, 23 male) with HF (8 with ischaemic cardiomyopathy), NYHA class III, left bundle branch block, left ventricular ejection fraction (LVEF) </=35% (mean 24+/-6%) who underwent CRT. All patients were taking conventional HF therapy and were clinically stable. Plasma BNP levels were evaluated by two-site dual-monoclonal immunochemiluminescent assay before, and 1 month after CRT. The predictive value of BNP was assessed using univariate and multivariate regression analyses.
  
  
  RESULTS
  During follow-up (mean 19+/-12 months), HF progression was observed in 14 patients (11 were hospitalised and 3 died after worsening of HF). Multivariate analysis showed that BNP levels before (HR: 2.07; CI: 1.19-3.62; p=0.01) and 1 month after CRT (HR: 2.23; CI: 1.26-3.94; p=0.006) were significantly related to events. At 1 month, a BNP level >91.5 pg/ml had 89% sensitivity, 59% specificity, and negative and positive predictive values of 96% and 33%, respectively, for HF progression after 12 months.
  
  
  CONCLUSIONS
  HF patients with high BNP values after 1 month of CRT have worse prognosis during follow-up. Therefore, in these patients other therapeutic options should be considered.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, The Brody School of Medicine, East Carolina University, 600 Moye Boulevard, 27834 Greenville, NC, USA. pitzalism@ecu.edu
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Pitzalis
authors.forename: Massimo
authors.initials: M
authors.lastname: Iacoviello
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Serio
authors.forename: Roberta
authors.initials: R
authors.lastname: Romito
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.forename: Elisabetta
authors.initials: E
authors.lastname: De Tommasi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Luzzi
authors.forename: Matteo
authors.initials: M
authors.lastname: Anaclerio
authors.forename: Lucia
authors.initials: L
authors.lastname: Varraso
authors.forename: Cinzia
authors.initials: C
authors.lastname: Forleo
authors.forename: Nicola
authors.initials: N
authors.lastname: Pansini
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010138:Pacemaker, Artificial; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis; D020257:Ventricular Remodeling
chemical_list: D020097:Natriuretic Peptide, Brain