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Eur J Heart Fail. 2006 Aug;8(5):509-14. Epub 2006 Feb 28.

Prognostic value of brain natriuretic peptide in the management of patients receiving cardiac resynchronization therapy.

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  • 1Department of Internal Medicine, Division of Cardiology, The Brody School of Medicine, East Carolina University, 600 Moye Boulevard, 27834 Greenville, NC, USA. pitzalism@ecu.edu

Abstract

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.

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PMID:
16503416
[PubMed - indexed for MEDLINE]
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