Brain natriuretic peptide and cardiac resynchronization therapy in patients with mildly symptomatic heart failure

Andrew Brenyo, Alon Barsheshet, Mohan Rao, David T. Huang, Wojciech Zareba, Scott McNitt, W. Jackson Hall, Derick R. Peterson, Scott D. Solomon, Arthur J. Moss, Ilan Goldenberg

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)998-1004
Number of pages7
JournalCirculation: Heart Failure
Volume6
Issue number5
DOIs
StatePublished - Sep 2013
Externally publishedYes

Keywords

  • Brain
  • Cardiac resynchronization therapy
  • Heart failure
  • Natriuretic peptide

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