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Positive Response to Cardiac Resynchronization Therapy : The Role of NT-proBNP

BAKOS, ZOLTAN LU ; REITAN, CHRISTIAN LU ; CHAUDHRY, UZMA LU ; WERTHER EVALDSSON, ANNA LU ; Roijer, Anders LU ; Wang, Lingwei LU ; Platonov, Pyotr LU and Borgquist, Rasmus LU (2016) In International journal of cardiovascular research 5(2).
Abstract
Abstract Background: Cardiac resynchronization therapy (CRT) is effective, but only 60-70% of patients benefit from the therapy. Despite numerous implantations, identification of predictive factors for response is still a challenge. We sought to assess the correlation of echocardiographic and clinical response to baseline demographics in relation to change in NT-proBNP levels at 6 months. Methods: 211 patients on optimal medical therapy were included retrospectively (72 ± 10 yrs., 66% LBBB, 48% DCMP, 80% male) and investigated at baseline and 6 months later. Improvement of ≥ 1 NYHA class was used as a marker for clinical response, and >15% reduction of left ventricular end-systolic volume was used to de ne reverse remodeling. NT-proBNP... (More)
Abstract Background: Cardiac resynchronization therapy (CRT) is effective, but only 60-70% of patients benefit from the therapy. Despite numerous implantations, identification of predictive factors for response is still a challenge. We sought to assess the correlation of echocardiographic and clinical response to baseline demographics in relation to change in NT-proBNP levels at 6 months. Methods: 211 patients on optimal medical therapy were included retrospectively (72 ± 10 yrs., 66% LBBB, 48% DCMP, 80% male) and investigated at baseline and 6 months later. Improvement of ≥ 1 NYHA class was used as a marker for clinical response, and >15% reduction of left ventricular end-systolic volume was used to de ne reverse remodeling. NT-proBNP levels were measured at baseline and at 6 months and were compared to echocardiographic and clinical response status.Results: Four groups were identi ed: 1) non-responder, 2) echo responder, 3) clinical responder, and 4) double responder (echo and clinical). Responders were younger (70 vs. 74 years, p=0.04), had better NYHA class (2.1 vs. 2.5, p=0.01) and had lower NT- proBNP compared to non-responders at baseline. NT-proBNP slightly increased or remained unchanged in non-responders, whereas reduction in NT-proBNP was of similar magnitude for clinical or echo responders, and was most pronounced for double responders. A reduction of NT-proBNP ≥25% separated non- responders from responders (p=0.01). No signi cant differences in NT-proBNP levels and no signi cant changes in NT-proBNP were found across the responder subgroups.Conclusion: Six-month reduction in NT-proBNP is most pronounced for “double responders, ” but was comparable in patients with either clinical or echo response. Lack of NT-proBNP reduction can help identify the non-responders for further intervention.Keywords Cardiac resynchronization therapy; Electrocardiography; Echocardiography (Less)
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author
organization
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Contribution to journal
publication status
published
subject
keywords
Cardiac resynchronization therapy; Electrocardiography; Echocardiography
in
International journal of cardiovascular research
volume
5
issue
2
ISSN
2324-8602
DOI
10.4172/2324-8602.1000259
language
English
LU publication?
yes
id
e5e015e1-8762-4481-be02-fc3e44288010
date added to LUP
2016-10-21 15:35:52
date last changed
2017-01-18 08:21:13
@article{e5e015e1-8762-4481-be02-fc3e44288010,
  abstract     = {Abstract Background: Cardiac resynchronization therapy (CRT) is effective, but only 60-70% of patients benefit from the therapy. Despite numerous implantations, identification of predictive factors for response is still a challenge. We sought to assess the correlation of echocardiographic and clinical response to baseline demographics in relation to change in NT-proBNP levels at 6 months. Methods: 211 patients on optimal medical therapy were included retrospectively (72 ± 10 yrs., 66% LBBB, 48% DCMP, 80% male) and investigated at baseline and 6 months later. Improvement of ≥ 1 NYHA class was used as a marker for clinical response, and >15% reduction of left ventricular end-systolic volume was used to de ne reverse remodeling. NT-proBNP levels were measured at baseline and at 6 months and were compared to echocardiographic and clinical response status.Results: Four groups were identi ed: 1) non-responder, 2) echo responder, 3) clinical responder, and 4) double responder (echo and clinical). Responders were younger (70 vs. 74 years, p=0.04), had better NYHA class (2.1 vs. 2.5, p=0.01) and had lower NT- proBNP compared to non-responders at baseline. NT-proBNP slightly increased or remained unchanged in non-responders, whereas reduction in NT-proBNP was of similar magnitude for clinical or echo responders, and was most pronounced for double responders. A reduction of NT-proBNP ≥25% separated non- responders from responders (p=0.01). No signi cant differences in NT-proBNP levels and no signi cant changes in NT-proBNP were found across the responder subgroups.Conclusion: Six-month reduction in NT-proBNP is most pronounced for “double responders, ” but was comparable in patients with either clinical or echo response. Lack of NT-proBNP reduction can help identify the non-responders for further intervention.Keywords Cardiac resynchronization therapy; Electrocardiography; Echocardiography},
  author       = {BAKOS, ZOLTAN and REITAN, CHRISTIAN and CHAUDHRY, UZMA and WERTHER EVALDSSON, ANNA and Roijer, Anders and Wang, Lingwei and Platonov, Pyotr and Borgquist, Rasmus},
  issn         = {2324-8602},
  keyword      = {Cardiac resynchronization therapy; Electrocardiography; Echocardiography},
  language     = {eng},
  month        = {03},
  number       = {2},
  series       = {International journal of cardiovascular research},
  title        = {Positive Response to Cardiac Resynchronization Therapy : The Role of NT-proBNP},
  url          = {http://dx.doi.org/10.4172/2324-8602.1000259},
  volume       = {5},
  year         = {2016},
}