Neurohormonal and inflammatory markers as predictors of short-term outcome in patients with heart failure and cardiac resynchronization therapy.
BACKGROUND
Cardiac resynchronization therapy is a modality with proven morbidity and mortality benefit in advanced systolic heart failure. Nevertheless, not all patients respond favorably to CRT. Natriuretic peptides and inflammatory markers are elevated in congestive heart failure and reflect disease severity.


OBJECTIVE
To test whether an early change in neurohormonal and inflammatory markers after implantation can predict the clinical response to CRT.


METHODS
The study group included 32 patients with advanced symptomatic systolic heart failure and a prolonged QRS complex who were assigned to undergo CRT. Baseline plasma levels of B-type natriuretic peptide and high sensitivity C-reactive protein were determined in the peripheral venous blood and coronary sinus, Post-implantation levels were determined 2 weeks post-procedure in the PVB. Baseline levels and their change in 2 weeks were correlated with all-cause mortality and hospitalization for congestive heart failure.


RESULTS
At baseline, coronary sinus levels of BNP but not hsCRP were significantly elevated compared to the PVB. Compared to baseline levels, BNP and hsCRP decreased significantly within 2 weeks after the implantation (BNP mean difference 229.1 +/- 102.5 pg/ml, 95% confidence interval 24.2-434, P< 0.0001; hsCRP mean difference 5.2 +/- 2.4 mg/dl, 95% CI 0.3-10.1, P= 0.001). During a mean follow-up of 17.7 +/- 8.2 months 6 patients died (18.7%) and 12 (37.5%) were hospitalized due to exacerbation of CHF. Baseline New York Heart Association and CSBNP levels predicted CHF-related hospitalizations. HsCRP levels or their change over 2 weeks did not predict all-cause mortality or hospitalizations.


CONCLUSIONS
BNP levels in the CS and peripheral venous blood during biventricular implantation and 2 weeks afterwards predict clinical response and may guide patient management.
Glick
Aharon
A
Department of Cardiology, Tel Aviv Sourasky Medical Center, Israel.
Michowitz
Yoav
Y
Keren
Gad
G
George
Jacob
J
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002304:Cardiac Pacing, Artificial; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018377:Neurotransmitter Agents / Q000097:blood; D010343:Patient Admission; D011237:Predictive Value of Tests; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D018377:Neurotransmitter Agents; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein