Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy.
BACKGROUND
Cardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF). However, >or= 30% of patients have no significant clinical or echocardiographic improvement following CRT. Reverse remodeling after CRT correlates with improved clinical outcomes. We hypothesized that in NT-pro BNP monitoring is accurate to identify responders following CRT.


METHODS
42 consecutive patients (mean age 66 +/- 12 years, male 68%) with HF undergoing CRT were prospectively enrolled. Responders at follow-up were defined by echocardiography (decrease in LV end systolic volume >or= 15%). Echocardiography and NT-pro BNP measurement were performed at baseline and repeated 3 to 6 month after CRT.


RESULTS
There was no significant difference between responders (n = 29, 69%) and non-responders (n = 13, 31%) regarding baseline NT-pro BNP level. Responders had significantly higher decrease in NT-pro BNP levels during follow-up than non-responders (absolute: -1428 +/- 1333 pg x ml-1 vs. -61 +/- 959 pg x ml-1, p = 0.002; relative: -45 +/- 28% vs. 2 +/- 28%, p < 0.0001). A decrease of >or= 15% in NT-pro BNP 3-6 months after CRT identifies echocardiographic responders with a sensitivity of 90% and a specificity of 77%.


CONCLUSIONS
NT-pro BNP monitoring can accurately identify echocardiographic responders after CRT.
Magne
Julien
J
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Cardiology, Quebec, Canada. mario.senechal@criucpq.ulaval.ca
Dubois
Michelle
M
Champagne
Jean
J
Dumesnil
Jean G
JG
Pibarot
Philippe
P
Philippon
François
F
O'Hara
Gilles
G
Sénéchal
Mario
M
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
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