title: Clinical, echocardiographic, and neurohormonal response to cardiac resynchronization therapy: are they interchangeable?
abstract: BACKGROUND
  The relationship between changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic or clinical definitions of response to cardiac resynchronization therapy (CRT) has not been evaluated. The aims of the present evaluation were to assess: (1) the relationship between changes in NT-proBNP after 6 months of CRT and clinical and echocardiographic responses; (2) the association between NT-proBNP changes and long-term outcome.
  
  
  METHODS
  In 170 patients treated with CRT (age 61 ± 11 years, 75% male), clinical and echocardiographic parameters and circulating NT-proBNP levels were assessed at baseline and 6 months after CRT. At 6 months follow-up, improvement in New York Heart Association class ≥ 1 point, decrease in left ventricular end-systolic volume ≥ 15%, and decrease in NT-proBNP ≥ 15% defined clinical, echocardiographic, and neurohormonal CRT response, respectively. All-cause mortality data were collected and related to neurohormonal response.
  
  
  RESULTS
  Neurohormonal, echocardiographic, and clinical response rates were 54%, 58%, and 66%, respectively. The majority of patients (71%) showing echocardiographic response had NT-proBNP reduction ≥ 15%. In contrast, only 58% of patients who showed clinical response also had NT-proBNP reduction ≥ 15%. During a median follow-up of 32 months, 40 patients died. Patients with neurohormonal response demonstrated a superior long-term outcome compared to patients without neurohormonal response (log-rank P = 0.02).
  
  
  CONCLUSIONS
  NT-proBNP reduction ≥ 15% showed better agreement with echocardiographic response compared to clinical response. Neurohormonal response was associated with superior long-term outcome compared to insufficient reduction in NT-proBNP levels.
authors.affiliation: Department of Cardiology.
authors.forename: Georgette E
authors.initials: GE
authors.lastname: Hoogslag
authors.forename: Ulas
authors.initials: U
authors.lastname: Höke
authors.forename: Joep
authors.initials: J
authors.lastname: Thijssen
authors.forename: Dominique
authors.initials: D
authors.lastname: Auger
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Harriette F
authors.initials: HF
authors.lastname: Verwey
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy / Q000401:mortality* / Q000706:statistics & numerical data*; D002908:Chronic Disease; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009426:Netherlands / Q000453:epidemiology; D018377:Neurotransmitter Agents / Q000097:blood; D010446:Peptide Fragments / Q000097:blood*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: NT-proBNP; cardiac resynchronization therapy; left ventricular reverse remodeling; outcome