title: Mid-regional pro-atrial natriuretic peptide to predict clinical course in heart failure patients undergoing cardiac resynchronization therapy.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) induces reverse cardiac remodelling in heart failure (HF), but many patients receiving CRT remain non-responders. This study assessed the role of amino-terminal-pro-B-type natriuretic peptide (NT-proBNP), mid-regional-pro-atrial natriuretic peptide (MR-proANP), and mid-regional-pro-adrenomedullin (MR-proADM) at the time of device implantation to predict favourable clinical course (CRT response and/or risk of MACE) in HF patients receiving CRT.
  
  
  RESULTS
  A total of 137 HF patients were prospectively included. Blood was drawn from the coronary sinus (CS) at CRT implantation, and from a peripheral vein (PV) simultaneously and after 6 months. Clinical CRT response at 6 months and major adverse cardiovascular events (MACE) at 2 years were assessed. Baseline PV-levels of MR-proANP (202 vs. 318 pmol/L, P = 0.009) and MR-proADM (843 vs. 1112 pmol/L, P = 0.02) were lower in CRT responders compared with non-responders. At 6 months, CRT responders showed a decrease in MR-proANP levels, compared with an increase in non-responders (-32 vs. +7 pmol/L, P = 0.02). During the same period, NT-proBNP decreased by a similar way in responders and non-responders, while MR-proADM was unchanged in both groups. High baseline MR-proANP, either in PV (OR 0.41, 95% CI 0.24-0.71, P = 0.002) or CS (OR 0.32, 95% CI 0.15-0.70, P = 0.005) was associated with reduced likelihood of CRT response. Furthermore, PV and CS levels of NT-proBNP, MR-proANP, and MR-proADM were all associated with increased risk of 2-year MACE (all P < 0.01).
  
  
  CONCLUSIONS
  Mid-regional-pro-atrial natriuretic peptide may assist prediction of clinical course in HF patients undergoing CRT implantation. Low circulating MR-proANP at the time of device implantation is associated with CRT response and more favourable outcome.
authors.affiliation: INSERM UMR-S 942, Paris, France.|Department of Anesthesiology and Critical Care Medicine, APHP, Saint Louis and Lariboisière University Hospitals, 2, rue Ambroise Paré, Paris 75010, France.|Department of Cardiology, APHP, Lariboisière University Hospitals, Paris, France.|Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Mattia
authors.initials: M
authors.lastname: Arrigo
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jackie
authors.initials: J
authors.lastname: Szymonifka
authors.affiliation: INSERM UMR-S 942, Paris, France.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Rivas-Lasarte
authors.affiliation: INSERM UMR-S 942, Paris, France.
authors.forename: Heli
authors.initials: H
authors.lastname: Tolppanen
authors.affiliation: INSERM UMR-S 942, Paris, France.
authors.forename: Malha
authors.initials: M
authors.lastname: Sadoune
authors.affiliation: INSERM UMR-S 942, Paris, France.|Department of Anesthesiology and Critical Care Medicine, APHP, Saint Louis and Lariboisière University Hospitals, 2, rue Ambroise Paré, Paris 75010, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.affiliation: INSERM UMR-S 942, Paris, France.|Department of Cardiology, APHP, Lariboisière University Hospitals, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.affiliation: Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.affiliation: INSERM UMR-S 942, Paris, France.|Department of Anesthesiology and Critical Care Medicine, APHP, Saint Louis and Lariboisière University Hospitals, 2, rue Ambroise Paré, Paris 75010, France.|Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D053607:Adrenomedullin / Q000097:blood; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor
keywords: Biomarker; Cardiac resynchronization therapy; Heart failure; MR-proADM; MR-proANP; NT-proBNP; Response