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

Abstract

BackgroundCardiac resynchronization therapy (CRT) is an established therapy for appropriately selected patients with heart failure. Response to CRT has been heterogeneously defined using both clinical and echocardiographic measures, with poor correlation between the two.MethodsThe study cohort was comprised of 202 CRT-treated patients and CRT response was defined at 6 months post-implant. Echocardiographic response (E+) was defined as a reduction in LVESV ≥ 15%, clinical response as an improvement of ≥ 1 NYHA class (C+), and biomarker response as a ≥ 25% reduction in NT-proBNP(B+). The association of response measures (E+, B+, C+; response score range 0–3) and clinical endpoints at 3 years was assessed in landmarked Cox models.ResultsEcho and clinical responders demonstrated greater declines in NT-proBNP than non-responders (median [E+/B+]: -52%, [E+]: -27%, [C+]: -39% and [E-/C-]: -13%; p = 0.01 for trend). Biomarker (HR 0.43 [95% CI: 0.22–0.86], p = 0.02) and clinical (HR 0.40 [0.23–0.70] p = 0.001) response were associated with a significantly reduced risk of the primary endpoint. When integrating each response measure into a composite score, each 1 point increase was associated with a 31% decreased risk for a composite endpoint of mortality, LVAD, transplant and HF hospitalization (HR 0.69 [95% CI: 0.50–0.96], p = 0.03), and a 52% decreased risk of all-cause mortality (HR 0.48 [95% CI: 0.26–0.89], p = 0.02).ConclusionSerial changes in NT-proBNP are associated with clinical outcomes following CRT implant. Integration of biomarker, clinical, and echocardiographic response may discriminate CRT responders versus non-responders in a clinically meaningful way, and with higher accuracy.Trial registrationThe cohort was combined from study NCT01949246 and the study based on local review board approval 2011/550 in Lund, Sweden.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0802-8) contains supplementary material, which is available to authorized users.

A Novel Risk Model for Mortality and Hospitalization following Cardiac Resynchronization Therapy in Patients with Non-ischemic Cardiomyopathy: The Alpha-score

“…It is known that inflammation plays an important role in the As a marker of ventricle dysfunction, the plasma NT pro-BNP level is a comprehensive index of cardiac function with high sensitivity and specificity. Similarly, in our study, elevated NT pro-BNP levels were an independent predictor of HF progression and mortality, which is consistent with several earlier studies [16,29,30].…”

“…Over the past decades, prior risk models [9, 10, [14][15][16] were derived with good calibration and accuracy in derivation cohorts or Western validation cohorts; however, Asian populations, especially The prevalence of ischemic HF in CRT candidates was greater than 50% in most studies [1,7,9,10,18] conducted in North America and Europe. However, the situation in Asia is significantly different with regards to the subtype of CRT candidates [19][20][21].…”

“…Some studies suggest that patient characteristics, such as severity of mitral insufficiency, renal failure, baseline LVEF and age, are risk factors for poor prognosis in patients receiving CRT[9, 16,42].…”

The Short-Term and Long-Term Effects of Cardiac Resynchronization Therapy in Heart Failure Patients

“…Elevation of these peptides has a well established role for prediction of mortality for both acute and chronic heart failure situations [16][17]. Bakos Z et al [18] found that BNP levels were significantly reduced in CRT responders compared to non-responders, and that the greatest reduction was seen in those patients who exhibited both a clinical and echocardiographic positive response. In contrast, patients with no BNP reduction had a poor prognosis with significantly higher mortality and heart failure hospitalizations.…”

A novel risk model for mortality and hospitalization following cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy: the alpha-score

“…Over the past decades, prior risk models [9,10,[14][15][16] were derived with good calibration and accuracy in derivation cohorts or Western validation cohorts; however, Asian populations, especially Chinese participants, are rarely used for validation [17]. VALID-CRT [11]and sex category, renal function, ECG/QRS width, ejection fraction, and NYHA class (ScREEN) [8] scores were derived and validated in European multicenter studies, and ejection fraction, atrial fibrillation, age, renal function, and NYHA class (EARRN) [10] does not have a validation population.…”