Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy

Julien Magne,Philippe Pibarot,François Philippon,Jean G Dumesnil,Gilles O'Hara,Jean Champagne,Mario Sénéchal,Michelle Dubois

doi:10.1186/1476-7120-7-39

Julien Magne, Philippe Pibarot + Show 6 more

Open Access

https://doi.org/10.1186/1476-7120-7-39

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Abstract

BackgroundCardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF). However, ≥ 30% of patients have no significant clinical or echocardiographic improvement following CRT. Reverse remodeling after CRT correlates with improved clinical outcomes. We hypothesized that in NT-pro BNP monitoring is accurate to identify responders following CRT.Methods42 consecutive patients (mean age 66 ± 12 years, male 68%) with HF undergoing CRT were prospectively enrolled. Responders at follow-up were defined by echocardiography (decrease in LV end systolic volume ≥ 15%). Echocardiography and NT-pro BNP measurement were performed at baseline and repeated 3 to 6 month after CRT.ResultsThere was no significant difference between responders (n = 29, 69%) and non-responders (n = 13, 31%) regarding baseline NT-pro BNP level. Responders had significantly higher decrease in NT-pro BNP levels during follow-up than non-responders (absolute: -1428 ± 1333 pg.ml-1 vs. -61 ± 959 pg.ml-1, p = 0.002; relative: -45 ± 28% vs. 2 ± 28%, p < 0.0001). A decrease of ≥ 15% in NT-pro BNP 3–6 months after CRT identifies echocardiographic responders with a sensitivity of 90% and a specificity of 77%.ConclusionNT-pro BNP monitoring can accurately identify echocardiographic responders after CRT.

Highlights

Cardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF)
Protocol Patients were submitted to clinical examination, 12-lead electrocardiography (EKG), blood sampling, transthoracic echocardiography (TTE), and dobutamine stress echocardiography (DSE) within one week before CRT
NT-pro Brain natriuretic peptides (BNP) at baseline and follow-up The decrease in NT-pro BNP following CRT was higher in responders than in non-responders (p = 0.002) (Figure 1)

Summary

Introduction

Cardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF). Reverse remodeling after CRT correlates with improved clinical outcomes. We hypothesized that in NT-pro BNP monitoring is accurate to identify responders following CRT. Reverse remodeling through pharmacological intervention and CRT correlates with improved clinical outcomes [6]. Left lateral wall pacing increases systolic function, reduces mitral regurgitation (MR) and decrease the wall motion stress. In this favorable remodeling process, neurohumoral activity is reduced and the decrease in plasma Btype natriuretic peptide after initiation of CRT predicts clinical improvement during follow-up [12]. We hypothesized that NT-pro BNP reduction following CRT correlates with LV remodeling and MR improvement and that change in NT-pro BNP following CRT can identify echocardiographic responders with good accuracy

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Conclusion