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

Abstract

Background-There are limited data on the prognostic implications of brain natriuretic peptide (BNP) assessment in patients with mildly symptomatic heart failure (HF) who receive cardiac resynchronization therapy with a defibrillator (CRT-D). Methods and Results-The effect of elevated baseline and 1-year BNP levels (dichotomized at the upper tertile BNP of 120 pg/ mL) on the risk of HF or death was assessed among the cohort of 1197 patients with baseline BNP data enrolled in MADIT (Multicenter Automated Defibrillator Implantation Trial)-CRT. Elevated baseline BNP was associated with a significant 68% (P=0.007) and 58% (P=0.02) increase in the risk of HF or death among MADIT-CRT patients allocated to CRT-D and implantable cardioverter defibrillator-only therapy, respectively. At 1 year of follow-up, patients allocated to CRT-D displayed significantly greater reductions in BNP (26% reduction) levels compared with implantable cardioverter defibrillator-only patients (8% increase; P=0.005). Patients with CRT-D in whom 1-year BNP levels were reduced or remained low experienced a significantly lower risk of subsequent HF or death as compared with patients in whom 1-year BNP levels were high. Similarly, the echocardiographic response to CRT-D was highest among those who maintained low BNP levels or in whom BNP level at 1-year was reduced. Conclusions-Our findings suggest that assessment of baseline and follow-up BNP provides important prognostic implications in patients with mildly symptomatic HF who receive CRT. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.(Circ Heart Fail. 2013;6:998-1004.)

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

“…We find this information to complement our findings that change in risk category at 6 months based on the combined biomarkers was associated with the primary outcome of HFH or death as well as with response to CRT. A recently published report from the MADIT CRT trial tells of the usefulness of BNP levels among patients with less‐advanced HF in predicting response to CRT . Similar to our findings of an association of subsequent improvement in biomarker profile with response to CRT, in the MADIT CRT trial report, CRT recipients demonstrated significantly larger decreases in BNP levels at 1 year compared to patients randomized to implantable cardioverter defibrillator implant that was particularly evident among those who responded to CRT.…”

Coronary sinus biomarker sampling compared to peripheral venous blood for predicting outcomes in patients with severe heart failure undergoing cardiac resynchronization therapy: The BIOCRT study

“…26 Our study extends to that finding by providing large sample of 73 CS patients and suggests that a multi-marker CS strategy with NT-proBNP, gal-3, and sST2 have prognostic potential for predicting MACE. While prior CRT studies have found that PV NT-proBNP or gal-3 was predictive of mortality and is an independent predictor of MACE, 27-29 both the PV NT-proBNP studies had over 800 CRT patients 27, 28 and the PV gal-3 study had 260 patients. 29 Our discrepant finding that no PV strategy was predictive of MACE may be explained by our small sample size.…”

Does cardiac resynchronization therapy restore peripheral circulatory homeostasis?

“…2 In addition, there was a significant reduction in the plasma concentrations of N-terminal proBNP, a similar finding to the CARE-HF trial. 2 In this regard, a post hoc analysis of the MADIT-CRT trial 21 found that reduction in BNP following CRT was associated with significant decrease in hospitalized heart failure and mortality.…”