European Heart Journal Advance Access originally published online on June 2, 2009
European Heart Journal 2009 30(17):2109-2116; doi:10.1093/eurheartj/ehp210
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Relationships between cardiac resynchronization therapy and N-terminal pro-brain natriuretic peptide in patients with heart failure and markers of cardiac dyssynchrony: an analysis from the Cardiac Resynchronization in Heart Failure (CARE-HF) study
1 Department of Cardiology, General Hospital of St Pölten, St Pölten, Austria
2 Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria
3 School of Health and Population Sciences, University of Birmingham, Birmingham, UK
4 Department of Internal Medicine, Medical University of Graz, Graz, Austria
5 Department of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
6 Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
7 Department of Cardiology, University of Hull, Kingston upon Hull, UK
Received 13 April 2008; revised 1 April 2009; accepted 4 May 2009; online publish-ahead-of-print 2 June 2009.
* Corresponding author. Tel: +43 140 400 4616, Fax: +43 1408 1148, Email: rudolf.berger{at}meduniwien.ac.at
Aims: The Cardiac Resynchronization in Heart Failure (CARE-HF) study showed that cardiac resynchronization therapy (CRT) reduces mortality in HF patients with markers of dyssynchrony. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) might predict which patients benefit most from CRT. We evaluated whether the prognostic value of NT-proBNP was influenced by CRT and the effects of CRT stratified according to NT-proBNP.
Methods and results: A total of 813 patients were enrolled in CARE-HF. Baseline log-transformed NT-proBNP independently predicted all-cause mortality, sudden death, and death from pump failure. In a multivariable model including log-transformed NT-proBNP, assignment to CRT remained independently associated with better prognosis without evidence of interaction. Stratifying patients according to the median NT-proBNP and to CRT treatment allocation, all-cause mortality was 12% if <median + CRT, 25% if <median + control group, 35% if 
median + CRT, and 51% if median + control group. There was no evidence of a difference in the relative effect of CRT across different values of NT-proBNP.
Conclusion: NT-proBNP retains its prognostic value in HF patients with CRT. Deploying CRT before the patients have reached end-stage HF may maximize the benefit of treatment.
Key Words: Heart failure • Cardiac resynchronization therapy • Natriuretic peptides • Prognosis