Neurohormonal and inflammatory markers as predictors of short-term outcome in patients with heart failure and cardiac resynchronization therapy

Aharon Glick, Yoav Michowitz, Gad Keren, Jacob George*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background: Cardiac resynchronization therapy is a modality with proven morbidity and mortality benefit in advanced systolic heart failure. Nevertheless, not all patients respond favorably to CRT. Natriuretic peptides and inflammatory markers are elevated in congestive heart failure and reflect disease severity. Objectives: To test whether an early change in neurohormonal and inflammatory markers after implantation can predict the clinical response to CRT. Methods: The study group included 32 patients with advanced symptomatic systolic heart failure and a prolonged QRS complex who were assigned to undergo CRT. Baseline plasma levels of B-type natriuretic peptide and high sensitivity C-reactive protein were determined in the peripheral venous blood and coronary sinus. Post-implantation levels were determined 2 weeks post-procedure in the PVB. Baseline levels and their change in 2 weeks were correlated with all-cause mortality and hospitalization for congestive heart failure. Results: At baseline, coronary sinus levels of BNP but not hsCRP were significanly elevated compared to the PVB. Compared to baseline levels, BNP and hsCRP decreased significantly within 2 weeks after the implantation (BNP mean difference 229.1 ± 102.5 pg/ml, 95% confidence interval 24.2-434, P < 0.0001; hsCRP mean difference 5.2 ± 2.4 mg/dl, 95% CI 0.3-10.1, P = 0.001). During a mean follow-up of 17.7 ± 8.2 months 6 patients died (18.7%) and 12 (37.5%) were hospitalized due to exacerbation of CHF. Baseline New York Heart Association and CSBNP levels predicted CHF-related hospitalizations. HsCRP levels or their change over 2 weeks did not predict all-cause mortality or hospitalizations. Conclusions- BNP levels in the CS and peripheral venous blood during biventricular implantation and 2 weeks afterwards predict cilinical response and may guide patient management.

Original languageEnglish
Pages (from-to)391-395
Number of pages5
JournalIsrael Medical Association Journal
Volume8
Issue number6
StatePublished - Jun 2006

Keywords

  • B-type natriuretic peptide
  • C-reactive protein
  • Cardiac resynchronization therapy
  • Congestive heart failure

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