A new biomarker of cardiac resynchronization therapy response: cGMP to mature BNP ratio
A new biomarker of cardiac resynchronization therapy response: cGMP to mature BNP ratio
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DOI：
10.1016/j.jjcc.2021.12.015
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发表时间：
2022-04-14
影响因子：
2.5
通讯作者：
Kusano, Kengo
中科院分区：
文献类型：
--
作者：
Yokoyama, Yasuhiro;Kataoka, Naoya;Kusano, Kengo
背景：尚未确定可以预测心脏再同步治疗（CRT）反应的生物标志物。本研究的目的是评估四种脑/B 型利钠肽 (BNP) 形式的单独测量与环磷酸鸟苷 (cGMP) 是否有助于预测超声心动图 CRT 反应者。方法：使用新开发的试剂盒测量 BNP 前体 (proBNP) 和总 BNP (= proBNP + 成熟 BNP)，同时使用商业试剂盒测量 proBNP (NT-proBNP) 的 N 末端片段 (NT-proBNP) 和 cGMP CRT 植入前一天的试剂盒。前瞻性研究了估计的成熟 BNP（emBNP = 总 BNP-proBNP）、cGMP 与每种 BNP 形式的比率以及其他三种 BNP 形式的浓度，以了解其预测 CRT 反应的能力。 CRT 应答者的定义是 6 个月随访时左心室射血分数改善 > 10% 和/或左心室收缩末期容积减少 > 15%。 结果：在 77 名患者中，46 名 (60%) 被归类为 CRT 应答者。在测量参数中，只有 cGMP 与 emBNP 比率的最高四分位数是 CRT 应答者的独立预测因子（比值比 4.87，95% 置信区间 1.25-18.89，p = 0.02）。 cGMP 与 emBNP 比率与 CRT 植入后一年内心力衰竭住院的累积事件相关（对数秩 p = 0.029）。结论：cGMP 与 emBNP 比率可用作 CRT 反应者的预测生物标志物。 （使用钠尿肽个体分子测量进行心脏再同步治疗反应者预测的临床研究：UMIN R0 0 0 038927）。(c) 2022 年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Biomarkers that can predict cardiac resynchronization therapy (CRT) response have not yet been identified. The purpose of this study was to assess whether individual measurements of four brain/B-type natriuretic peptide (BNP) forms, coupled with cyclic guanosine monophosphate (cGMP) might contribute to the prediction of echocardiographic CRT responders.Methods: A BNP precursor (proBNP) and total BNP (= proBNP + mature BNP) were measured with newly developed kits, while an N-terminal fragment of proBNP (NT-proBNP) and cGMP were measured with commercial kits on the day before CRT implantation. Estimated mature BNP (emBNP = total BNP- proBNP), and the ratio of cGMP to each BNP form, as well as the concentrations of three other BNP forms, were prospectively investigated for their capability in predicting a response to CRT. A CRT responder was defined as an improvement in left ventricular ejection fraction > 10% and/or a reduction in left ventricular end-systolic volume > 15% at 6-month follow-up.Results: Out of 77 patients, 46 (60%) were categorized as CRT responders. Among the measurement parameters, only the highest quartile of the cGMP to emBNP ratio was an independent predictor of CRT responders (odds ratio 4.87, 95% confidence interval 1.25-18.89, p = 0.02). The cGMP to emBNP ratio was associated with the cumulative events of heart failure hospitalization within one year following CRT implantation (log-rank p = 0.029).Conclusions: The cGMP to emBNP ratio could be utilized as a predictive biomarker of CRT responders. (Clinical Study on Responder Prediction in Cardiac Resynchronization Therapy Using Individual Molecular Measurement of Natriuretic Peptide: UMIN R0 0 0 038927).(c) 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.