Prognostic value of brain natriuretic peptide in the management of patients receiving cardiac resynchronization therapy.
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.
Pitzalis
Maria Vittoria
MV
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
Iacoviello
Massimo
M
Di Serio
Francesca
F
Romito
Roberta
R
Guida
Pietro
P
De Tommasi
Elisabetta
E
Luzzi
Giovanni
G
Anaclerio
Matteo
M
Varraso
Lucia
L
Forleo
Cinzia
C
Pansini
Nicola
N
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
D020097:Natriuretic Peptide, Brain