Brain Natriuretic Peptide and Cardiac Resynchronization Therapy in Patients With Mildly Symptomatic Heart Failure
Brain Natriuretic Peptide and Cardiac Resynchronization Therapy in Patients With Mildly Symptomatic Heart Failure
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DOI：
10.1161/circheartfailure.112.000174
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发表时间：
2013-09-01
影响因子：
9.7
通讯作者：
Goldenberg, Ilan
中科院分区：
文献类型：
--
作者：
Brenyo, Andrew;Barsheshet, Alon;Goldenberg, Ilan
背景：关于脑钠肽（BNP）评估对接受除颤器（CRT-D）心脏除颤治疗的轻度症状性心力衰竭（HF）患者的预后影响的数据有限。在1197名有基线BNP数据的患者队列中评估了（在BNP 120 pg/mL的上三分位数处二分）对HF或死亡风险的影响（多中心自动除颤器植入试验）-CRT。在分配接受CRT-D和仅植入式心律转复除颤器治疗的MADIT-CRT患者中，基线BNP升高分别与HF或死亡风险显着增加68%（P=0.007）和58%（P=0.02）相关。在1年随访时，与仅植入式心律转复除颤器的患者（增加8%; P=0.005）相比，分配至CRT-D的患者显示BNP水平显著降低（降低26%）。与1年BNP水平较高的患者相比，1年BNP水平降低或保持较低水平的CRT-D患者发生后续HF或死亡的风险显著降低。同样，超声心动图反应CRT-D是最高的那些谁保持低BNP水平或在其中BNP水平在1年reduced.Conclusions我们的研究结果表明，基线和后续BNP的评估提供了重要的预后意义，在轻度症状的HF患者接受CRT.Clinical Trial Registration URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00180271。
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.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.