Usefulness of brain natriuretic peptide release as a surrogate marker of the efficacy of long-term cardiac resynchronization therapy in patients with heart failure

Sinha, Anil‐Martin; Filzmaier, Karsten; Breithardt, Ole A.; Kunz, Dagmar; Graf, Jürgen; Markus, Kai U.; Hanrath, Peter; Stellbrink, Christoph

doi:10.1016/s0002-9149(02)03425-2

Cited by 57 publications

(31 citation statements)

References 20 publications

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“…A study performed in 17 patients who received BiV stimulation for more than 6 months showed that only patients with a BNP rate less than the median during stimulation had inverse remodeling compared with the values before implantation. 26 In the present study, neurohormonal activation was diminished in the group with no clinical events. We observed that when LVEF improved, hypokinetic or even dyskinetic segments recovered normal contractility.…”

Section: Neurohumoral Activation and Crtsupporting

confidence: 51%

Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients

Dauphin

Nonin

Bontemps

et al. 2011

Circ: Cardiovascular Imaging

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Background-Phase analysis, developed to assess dyssynchrony from ECG-gated radionuclide ventriculography, has shown promising results. We hypothesized that quantifying the cardiac resynchronization reserve, that is, the extent of response to cardiac resynchronization therapy (CRT), by radionuclide imaging could potentially identify patients who are best suited for CRT. Methods and Results-Seventy-four patients ages 64.8Ϯ10.1 years were prospectively studied from July 2004 to July 2006, of whom 62.2% and 37.8%, respectively, were in New York Heart Association class 3 and 4. Mean QRS width was 173Ϯ25 ms. ECG-gated radionuclide ventriculography to quantify interventricular and intraventricular dyssynchrony was performed at baseline with and without CRT and at the 3-month follow-up visit. Amino-terminal-pro-brain natriuretic peptide (NT-pro-BNP) levels were also determined at baseline and at 3 months. During a mean follow-up of 10.1Ϯ7.6 months, there were 37 (50%) clinical events that defined the nonresponder group, including cardiac death or readmission for worsening heart failure. In multivariate Cox model analysis, higher NT-pro-BNP blood levels were associated with a significant increase in the risk for event (hazard ratioϭ1.085 for a 100 pg/L increase in NT-pro-BNP; 95% confidence interval, 1.014 to 1.161). Each 10°elevation in intraventricular dyssynchrony was associated with a decrease in the risk of events (hazard ratioϭ0.456, 95% confidence interval, 0.304 to 0.683). Receiver operating characteristic curve analysis demonstrated that an interventricular dyssynchrony cutoff value of 25.5°for intraventricular synchrony yielded 91.4% sensitivity and 84.4% specificity for predicting a good response to CRT. Conclusions-The

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Section: Neurohumoral Activation and Crtsupporting

confidence: 51%

Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients

Dauphin

Nonin

Bontemps

et al. 2011

Circ: Cardiovascular Imaging

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Clinical Perspective On P 1004mentioning

confidence: 99%

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

Brenyo

Barsheshet

Rao

et al. 2013

Circ: Heart Failure

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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.)

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“…7 Second, CRT is associated with beneficial neurohormonal effects, such as a decrease in brain natriuretic peptide levels. 8 Biventricular pacing has been shown to improve heart rate variability, a marker of increased mortality and arrhythmia susceptibility in patients with HF. 9 Finally, CRT appears to exert a beneficial effect on electrical remodeling in the failing heart.…”

Section: Discussionmentioning

confidence: 99%

Biventricular pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

et al. 2006

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SummaryBackground: Cardiac resynchronization therapy (CRT) has recently emerged as a new modality for the treatment of patients with advanced heart failure (HF).Hypothesis: Cardiac resynchronization therapy reduces atrial and ventricular arrhythmia burdens.Methods: We analyzed the clinical data of patients who underwent an upgrade from a dual-chamber to a biventricular implantable cardioverter-defibrillator (ICD) at a tertiary care center.Results: Nineteen patients (age 67 ± 10 years, 18 men, left ventricular [LV] ejection fraction 0.24 ± 0.07) underwent an upgrade to CRT-ICD. The LV lead was placed in a lateral position in 11, posterolateral in 4, and anterolateral in 3 patients. Baseline New York Heart Association class of HF improved in 11 (58%) patients who were considered "responders." After adjusting for the duration of follow-up before and after the upgrade, the number of patients receiving any ICD therapy decreased significantly from 13 to 4 (p = 0.004) and the total number of therapies decreased from 72 to 17 (p = 0.067). Also, the number of detections of sustained ventricular arrhythmias decreased from 40 to 11 episodes (p = 0.05), but the decrease in the number of detected supraventricular arrhythmias and mode switch episodes was not significant. The reduction in the ventricular arrhythmia load was independent of whether or not the patient responded to CRT.

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Usefulness of brain natriuretic peptide release as a surrogate marker of the efficacy of long-term cardiac resynchronization therapy in patients with heart failure

Cited by 57 publications

References 20 publications

Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients

Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients

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

Biventricular pacing reduces ventricular arrhythmic burden and defibrillator therapies in patients with heart failure

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