© 2005 European Society of Cardiology
Prognostic value of brain natriuretic peptide in the management of patients receiving cardiac resynchronization therapy
a Department of Internal Medicine, Division of Cardiology, The Brody School of Medicine, East Carolina University 600 Moye Boulevard, 27834 Greenville, NC, USA
b Institute of Cardiology, University of Bari Italy
c UO Patologia Clinica I-Policlinico Bari, Italy
d Institute of Cardiology, "Salvatore Maugeri" Foundation IRCCS Cassano, Italy
* Corresponding author. Tel.: +1 252 744 1429; fax: +1 252 744 5884. E-mail address: pitzalism{at}ecu.edu
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Abstract |
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Objective: To evaluate the role of brain natriuretic peptide (BNP) in predicting the progression of heart failure (HF) after cardiac resynchronization therapy (CRT).
Background: It has been shown that BNP predicts the prognosis and can guide the treatment of HF.
Methods: We studied 50 consecutive patients (61±10 years, 23 male) with HF (8 with ischaemic cardiomyopathy), NYHA class III, left bundle branch block, left ventricular ejection fraction (LVEF) 
35% (mean 24±6%) who underwent CRT. All patients were taking conventional HF therapy and were clinically stable. Plasma BNP levels were evaluated by two-site dual-monoclonal immunochemiluminescent assay before, and 1 month after CRT. The predictive value of BNP was assessed using univariate and multivariate regression analyses.
Results: During follow-up (mean 19±12 months), HF progression was observed in 14 patients (11 were hospitalised and 3 died after worsening of HF). Multivariate analysis showed that BNP levels before (HR: 2.07; CI: 1.19–3.62; p=0.01) and 1 month after CRT (HR: 2.23; CI: 1.26–3.94; p=0.006) were significantly related to events. At 1 month, a BNP level >91.5 pg/ml had 89% sensitivity, 59% specificity, and negative and positive predictive values of 96% and 33%, respectively, for HF progression after 12 months.
Conclusions: HF patients with high BNP values after 1 month of CRT have worse prognosis during follow-up. Therefore, in these patients other therapeutic options should be considered.
Key Words: Heart failure • Cardiac resynchronization therapy • Echocardiography • Ventricular remodelling • Brain natriuretic peptide
Received May 13, 2005; Revised September 13, 2005; Accepted October 19, 2005
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