Generic placeholder image

Current Pharmaceutical Design


ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

General Research Article

Clinical Usefulness of N-terminal Prohormone of Brain Natriuretic Peptide and High Sensitivity Troponin T in Patients with Heart Failure Undergoing Cardiac Resynchronization Therapy

Author(s): Agnieszka Debska-Kozlowska, Marcin Ksiazczyk*, Izabela Warchol and Andrzej Lubinski

Volume 25 , Issue 14 , 2019

Page: [1671 - 1678] Pages: 8

DOI: 10.2174/1381612825666190621155718

Price: $65


Background: Cardiac resynchronization therapy (CRT) is a valuable intracardiac device-­based treatment option for a subgroup of patients with advanced heart failure (HF) and QRS prolongation. However, still a significant proportion of patients do not benefit from CRT implantation, labeled as non-responders.

Objectives: The aim of the present study was to evaluate the N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) and high sensitivity troponin T (cTnThs) value as predictors of CRT response in a 12-month observation.

Materials and Methods: The study included 46 patients with HF and implanted CRT-D. Levels of NT-pro BNP and cTnThs were assessed during a 12 month follow up.

Results: 46 consecutive patients (76% men) with a mean age of 64±8 were observed for 12 months. The CRT response criteria was met by 26 patients (56,5%). A significant decline in the NT-pro BNP concentrations was documented in responders (p=0.001). Moreover, ΔNT-pro BNP by at least 579 pg/ml had high sensitivity and specificity for identifying the CRT responders. There were no statistically significant differences in the results of cTnThs between the two study groups.

Conclusion: The relative change in the level of NT-pro BNP by at least 43,5% allows to identify the responders to CRT after 12 months of follow-up. Serial measurements of NT-pro BNP can be a valuable tool for monitoring the effectiveness of CRT.

Keywords: Cardiac resynchronization therapy, heart failure, high sensitivity troponin T, N-terminal prohormone of brain natriuretic peptide, CRT responders, CRT non-responders.

Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18(8): 891-975. []. [PMID: 27207191].
Mamas MA, Sperrin M, Watson MC, et al. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Eur J Heart Fail 2017; 19(9): 1095-104. []. [PMID: 28470962].
Versteeg H, Schiffer AA, Widdershoven JW, Meine MM, Doevendans PA, Pedersen SS. Response to cardiac resynchronization therapy: is it time to expand the criteria? Pacing Clin Electrophysiol 2009; 32(10): 1247-56. []. [PMID: 19702599].
Bristow MR, Saxon LA, Boehmer J, et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable cardioverter defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140-50. []. [PMID: 15152059].
Bilchick KC, Lardo AC. Cardiac resynchronization therapy: Application of imaging to optimize patient selection and assess response. Curr Heart Fail Rep 2008; 5(3): 119-27. []. [PMID: 18752761].
Shalaby AA, Abraham WT, Fonarow GC, et al. Association of BNP and Troponin Levels with Outcome among Cardiac Resynchronization Therapy Recipients. Pacing Clin Electrophysiol 2015; 38(5): 581-90. []. [PMID: 25677851].
Sugiura T, Takase H, Toriyama T, Goto T, Ueda R, Dohi Y. Circulating levels of myocardial proteins predict future deterioration of congestive heart failure. J Card Fail 2005; 11(7): 504-9. []. [PMID: 16198245].
Troughton R, Michael Felker G, Januzzi JL Jr. Natriuretic peptide-guided heart failure management. Eur Heart J 2014; 35(1): 16-24. []. [PMID: 24216390].
Davoodi G, Bagheri A, Yamini-Sharif A, Boroumand M, Saroukhani S, Sahebjam M. Evaluation of in-hospital NT-proBNP changes in heart failure patients to identify the six-month clinical response following cardiac resynchronization therapy. Acta Med Iran 2014; 52(1): 15-23. [PMID: 24658981].
Ding LG, Hua W, Zhang S, et al. Decrease of plasma N-terminal pro beta-type natriuretic peptide as a predictor of clinical improvement after cardiac resynchronization therapy for heart failure. Chin Med J (Engl) 2009; 122(6): 617-21. [PMID: 19323922].
Lellouche N, De Diego C, Cesario DA, et al. Usefulness of preimplantation B-type natriuretic peptide level for predicting response to cardiac resynchronization therapy. Am J Cardiol 2007; 99(2): 242-6. []. [PMID: 17223426].
Yu CM, Fung JW, Zhang Q, et al. Improvement of serum NT-ProBNP predicts improvement in cardiac function and favorable prognosis after cardiac resynchronization therapy for heart failure. J Card Fail 2005; 11(5)(Suppl.): S42-6. []. [PMID: 15948100].
Fruhwald FM, Fahrleitner-Pammer A, Berger R, et al. Early and sustained effects of cardiac resynchronization therapy on N-terminal pro-B-type natriuretic peptide in patients with moderate to severe heart failure and cardiac dyssynchrony. Eur Heart J 2007; 28(13): 1592-7. []. [PMID: 17298973].
Magne J, Dubois M, Champagne J, et al. Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy. Cardiovasc Ultrasound 2009; 7: 39. []. [PMID: 19695099].
Aarones M, Gullestad L, Aakhus S, et al. Prognostic value of cardiac troponin T in patients with moderate to severe heart failure scheduled for cardiac resynchronization therapy. Am Heart J 2011; 161(6): 1031-7. []. [PMID: 21641347].
Nauffal V, Tanawuttiwat T, Zhang Y, et al. Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients: The HF-CRT score. Heart Rhythm 2015; 12(12): 2387-94. []. [PMID: 26190316].

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy