Association of BNP and Troponin Levels with Outcome among Cardiac Resynchronization Therapy Recipients

Abstract

Introduction We conducted a prospective multicenter study to assess the prognostic value of combined baseline pre-implant plasma levels of the biomarkers cardiac troponin T (TnT) and BNP among CRT-D recipients. Methods At CRT-D implant, patients were stratified based on detectable TnT (≥0.01 ng/ml) and elevated BNP (predefined as >440 pg/ml) levels. Patients were classified into 3 groups high (both detectable TnT and high BNP), intermediate (either detectable TnT or high BNP), or low (non-detectable TnT and low BNP). Patients were followed for 12 months. Survival curves free from mortality or HFH were assessed. To assess the predictive value of biomarker category, we constructed a multivariate Cox regression model, including the covariates of age, NYHA class, LVEF, and QRS duration. Results A total of 267 patients (age 66 ± 12 years, males 80%, LVEF 25% ± 8%, ischemic CM 52%, QRSd 155 ± 26 ms) were studied. After one year, there were 13 deaths and 25 HFH events. A significant difference in event free survival among the 3 groups was observed, with high and intermediate categories having worse survival than low (log-rank test, p <0.001). In the multivariate model, risk category was a significant predictor of outcome: Hazard ratios were 7.34 (95% CI: 2.48 to 21.69) and 2.50 (95% CI: 1.04 to 6.04) for high and intermediate risk groups respectively (p<0.0001). Conclusion Among CRT-D recipients, baseline TnT and BNP values alone or in combination provide significant prognostic value for the outcome of mortality or HFH.

Evaluating the effects of cardiac resynchronization therapy on pathophysiological pathways of heart failure using surrogate biomarkers

“…Comprehensive investigations have been carried out on the biological role and the potential clinical applications of the natriuretic peptides. Many studies have shown that a significant decrease in BNP levels occurs after CRT, resulting in a good prognosis [17]. The results obtained in this study are comparable to those of the previous studies.…”

Prediction of clinical outcome in patients treated with cardiac resynchronization therapy - the role of NT-ProBNP and a combined response score

“…Elevation of these peptides has a well-established role for prediction of mortality for both acute and chronic heart failure situations [ 35 , 36 ]. In the CRT setting, the evidence for baseline BNP levels to predict clinical outcome is ambiguous; higher levels of BNP pre-implant have been correlated to higher risk of 1 year adverse events post-implant by some investigators [ 37 , 38 ], but other studies have not shown any correlation of baseline BNP to CRT-response [ 39 ]. Most likely this is due to the fact that successful CRT treatment can occur regardless of baseline BNP levels, and depends on a number of factors unassociated with baseline BNP levels, hence the resynchronization effect (and clinical outcome) is hard to predict by this metric.…”

Biomarkers to predict the response to cardiac resynchronization therapy

“…5 Further evidence for the usefulness of BNP as a predictor of the CRT response was obtained in a prospective follow-up study of 267 HF patients with an average LVEF of 25% ± 8% (mean þ SD) undergoing CRT-D implantation. 6 Both individually and in combination, baseline high-sensitivity troponin T (hsTnT) and BNP values-in a multivariate Cox regression model including age, NYHA class, LVEF, and QRS duration-were independent predictors of outcome, defined as death or HF hospitalization. A risk category based on the elevation of two, only one, or none of the investigated biomarkers, proved a significant predictor of outcome, with respective hazard ratios (HRs) of 7.34 [95% confidence interval (CI) 2.48-21.69] and 2.50 (95% CI 1.04-6.04) for high-and intermediate risk groups.…”