Decrease in plasma B‐type natriuretic peptide early after initiation of cardiac resynchronization therapy predicts clinical improvement at 12 months

Abstract

Background: Decrease in neurohormonal activation during pharmacotherapy for chronic heart failure (CHF) is associated with haemodynamic and clinical improvement. We tested the hypothesis that changes in neurohormonal activation after initiation of cardiac resynchronization therapy (CRT) predict its long-term clinical effect. Methods: The study group included 43 patients with CHF (37 males, mean age 62 T 9 years, NYHA class 3.2 T 0.4, QRS duration 195 T24 ms) who underwent successful implantation of a CRT system. Pharmacotherapy remained stable during the first 3 months of follow-up. Plasma levels of B-type natriuretic peptide (BNP) and big endothelin-1 (big ET-1) were evaluated before and 3 months after implantation. Clinical, echocardiographic and exercise parameters were monitored for a mean period of 25.8 T 6.7 months. Results: At 12 months of follow-up 13 non-responders were identified (no improvement in NYHA class (n = 10), urgent heart transplantation (n = 2) and death due to progressive heart failure (n = 1)). CRT resulted in a significant reduction in neurohormone levels (BNP 345.4 T 346 vs. 267.7 T 320.8 pg/ml, p < 0.01, big ET-1 3.11 T1.50 vs. 2.50 T 1.56 fmol/ml p < 0.05), especially in responders. Percentage change in BNP level was a stronger predictor of long-term clinical improvement than clinical, echocardiographic and exercise parameters at 3 months of follow-up. Conclusions: Percentage change in plasma BNP levels from baseline to 3 months was the strongest predictor of long-term response to CRT and may have potential to predict outcome.

Brain Natriuretic Peptide and Cardiac Resynchronization Therapy in Patients With Mildly Symptomatic Heart Failure

“…This discordance may possibly be because of the relatively small sample size and the retrospective design of the study by Lellouche et al 15 Several prior studies have examined the association between changes in BNP levels after CRT-D implantation and the subsequent echocardiographic and clinical response to the device. 11,12,[16][17][18][19][20][21] These studies, conducted in patients with advanced HF symptoms, have consistently shown that CRT-D-induced LV remodeling is associated with corresponding reductions in both short-and long-term BNP levels. In addition, it supports BNP change as indicative of clinical outcome.…”

“…[11][12][13][14][15][16][17][18][19][20][21] BNP is produced and secreted by the ventricular cardiac myocyte in response to myocardial stretch and elevated ventricular filling pressures. 22 Resulting plasma BNP concentrations are higher in patients with more severe symptoms or worse left ventricular (LV) function and are a powerful predictor of mortality and subsequent HF.…”

Clinical Status and B-Type Natriuretic Peptide Levels in Patients with Heart Failure at Hospital Discharge

“…NS: not significant. in patients with a "favorable prognosis" ranged from 200 to 300 pg/ml [2,14,21,22]. However, as BNP levels do become lower with cardiac compensation, it is theoretically possible to assess the degree of success in therapy and prognosis not only according to absolute values, but also according to percentages of BNP reduction during therapy [14].…”

“…Another difficulty encountered is a marked spread of BNP values in groups undergoing BNP evaluation, as expressed by SD (standard deviation) values identical or even exceeding mean values in the investigated group [3,14]. Thus, mean values in groups under comparison differ, while absolute values of individual patients in groups overlap [5].…”

Short term effect of CRT on biomarkers of cardiac remodelling and fibrosis: NT-proBNP, sST2, galectin-3, and a marker of oxidative stress — ceruloplasmin — A pilot study

“…Several studies showed the effect of CRT on clinical, echocardiographic parameters, and also on the markers of neurohumoral activation. Change of BNP concentration after CRT predicted clinical improvement of heart failure patients at one year follow-up [3].…”