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European Heart Journal Advance Access published online on February 13, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl505
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Early and sustained effects of cardiac resynchronization therapy on N-terminal pro-B-type natriuretic peptide in patients with moderate to severe heart failure and cardiac dyssynchrony

Friedrich M. Fruhwald1,*, Astrid Fahrleitner-Pammer1, Rudolf Berger2, Francisco Leyva3, Nick Freemantle4, Erland Erdmann5, Daniel Gras6, Lukas Kappenberger7, Luigi Tavazzi8, Jean-Claude Daubert9 and John G.F. Cleland10

1 Division of Cardiology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria
2 Department of Internal Medicine II, Medical University Vienna, Vienna, Austria
3 Good Hope Hospital, Sutton Coldfield, UK
4 University of Birmingham, Edgbaston, Birmingham, UK
5 Department of Internal Medicine III, University of Cologne, Cologne, Germany
6 Nouveles Cliniques Nantaises, Nantes, France
7 Division of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
8 IRCCS Policlinico San Matteo, Pavia, Italy
9 Centre Cardio-Pneumologique, University Hospital Rennes, Rennes, France
10 Department of Cardiology, University of Hull, Kingston upon Hull, UK

Received 26 January 2006; revised 12 May 2006; accepted 11 January 2007.

* Corresponding author. Tel: +49 43 316 385 2544; fax: +49 43 316 385 3733. E-mail address: friedrich.fruhwald{at}meduni-graz.at

AIMS: The Cardiac Resynchronization-Heart Failure (CARE-HF) study demonstrated that cardiac resynchronization therapy (CRT) could reduce morbidity and mortality and improve cardiac function in patients with moderate or severe heart failure secondary to left ventricular systolic dysfunction and markers of cardiac dyssynchrony. The purpose of this analysis was to investigate the effect of CRT on plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), a powerful marker of cardiac dysfunction and prognosis.

METHODS AND RESULTS: Blood samples were collected routinely at baseline and 3 and 18 months. Plasma was separated by cool centrifugation and stored at –70°C until transported to a central laboratory for analysis of NT-pro-BNP using a standard commercial assay. Cardiac function was assessed echocardiographically. At baseline, median plasma concentration of NT-pro-BNP was similar in patients assigned to CRT or medical therapy [1920 pg/mL (inter-quartile range (IQR) 744–4288) and 1809 pg/mL (IQR 719–3949), respectively]. The differences in medians between the CRT and medical therapy groups were highly significant at both 3 months (537 pg/mL; P < 0.0001) and 18 months of follow-up (567 pg/mL; P < 0.0001). These differences could not be accounted for by changes in pharmacological therapy or renal function but were associated with improvement in ventricular volumes and function.

CONCLUSION: CRT exerts an early and sustained reduction in NT-pro-BNP. This appears to reflect improvements in ventricular function. NT-pro-BNP may be a simple method for monitoring the effects of CRT.

Key Words: Heart failure • Cardiac resynchronization therapy • Neurohormones • NT-pro-BNP


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