Abstract 12189: The Ratio of Cyclic Guanosine Monophosphate to Brain Natriuretic Peptide (cGMP/BNP) Stratifies The Risk of Heart Failure Hospitalization in Cardiac Resynchronization Therapy (CRT) Patients

Abstract

Background: Cardiac Resynchronization Therapy (CRT) is established treatment for patients with heart failure, however, there are various predictors of prognosis. Although CRT responder is reported to have a better prognosis than CRT non-responder, some cases have poor clinical outcomes even among CRT responders. Meanwhile, brain natriuretic peptide (BNP) and cyclic guanosine monophosphate (cGMP) are associated with the severity of heart failure. Little is known about the efficacy of prognostic value of BNP and cGMP in CRT patients especially among CRT responders. Methods: Among 246 consecutive CRT patients, we retrospectively analyzed 86 patients whose biomarkers were measured at the time of implantation. The patients were divided into two groups by the median value of cGMP/BNP (0.26). The endpoint was heart failure hospitalization, and the CRT responder was defined as an improvement of end-systolic volume (ESV) ≥ 15% or ejection fraction (EF) ≥ 10% at 6 months after CRT implantation. Results: The patients were 65.4 ± 13.6 years old, 64 (74%) patients were male, 17 (20%) patients were ischemic cardiomyopathy, and 47 (55%) patients were CRT responders. During a median follow-up period of 830 (interquartile range: 482-1246) days, 27 patients (31%) had heart failure hospitalization (high cGMP/BNP group: 8 vs low cGMP/BNP group 19, p = 0.016). Kaplan-Meier analysis revealed the risk of heart failure hospitalization was higher in high cGMP/BNP group than in low group (log-rank p = 0.0025), and the same result was observed even among CRT responders (log-rank p=0.018). cGMP/BNP increased in responders (p = 0.0045) but not in non-responders (p = 0.23) at 6 months after CRT implantation in Wilcoxon signed-rank test. Univariate analysis showed that BMI, chronic kidney disease, diabetes mellitus, hemoglobin, CRT responder, and cGMP/BNP were predictors of heart failure hospitalization. Conclusion: cGMP/BNP is useful for the heart failure risk stratification in CRT patients.