| Neurohormonal and inflammatory markers as predictors of short-term outcome in patients with heart failure and cardiac resynchronization therapy. | |
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MedLine Citation:
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PMID: 16833167 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Cardiac resynchronization therapy is a modality with proven morbidity and mortality benefit in advanced systolic heart failure. Nevertheless, not all patients respond favorably to CRT. Natriuretic peptides and inflammatory markers are elevated in congestive heart failure and reflect disease severity. OBJECTIVES: To test whether an early change in neurohormonal and inflammatory markers after implantation can predict the clinical response to CRT. METHODS: The study group included 32 patients with advanced symptomatic systolic heart failure and a prolonged QRS complex who were assigned to undergo CRT. Baseline plasma levels of B-type natriuretic peptide and high sensitivity C-reactive protein were determined in the peripheral venous blood and coronary sinus, Post-implantation levels were determined 2 weeks post-procedure in the PVB. Baseline levels and their change in 2 weeks were correlated with all-cause mortality and hospitalization for congestive heart failure. RESULTS: At baseline, coronary sinus levels of BNP but not hsCRP were significantly elevated compared to the PVB. Compared to baseline levels, BNP and hsCRP decreased significantly within 2 weeks after the implantation (BNP mean difference 229.1 +/- 102.5 pg/ml, 95% confidence interval 24.2-434, P< 0.0001; hsCRP mean difference 5.2 +/- 2.4 mg/dl, 95% CI 0.3-10.1, P= 0.001). During a mean follow-up of 17.7 +/- 8.2 months 6 patients died (18.7%) and 12 (37.5%) were hospitalized due to exacerbation of CHF. Baseline New York Heart Association and CSBNP levels predicted CHF-related hospitalizations. HsCRP levels or their change over 2 weeks did not predict all-cause mortality or hospitalizations. CONCLUSIONS: BNP levels in the CS and peripheral venous blood during biventricular implantation and 2 weeks afterwards predict clinical response and may guide patient management. |
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Authors:
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Aharon Glick; Yoav Michowitz; Gad Keren; Jacob George |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Israel Medical Association journal : IMAJ Volume: 8 ISSN: 1565-1088 ISO Abbreviation: Isr. Med. Assoc. J. Publication Date: 2006 Jun |
Date Detail:
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Created Date: 2006-07-12 Completed Date: 2006-07-27 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 100930740 Medline TA: Isr Med Assoc J Country: Israel |
Other Details:
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Languages: eng Pagination: 391-5 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Tel Aviv Sourasky Medical Center, Israel. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Biological Markers / blood C-Reactive Protein / metabolism Cardiac Pacing, Artificial* Female Follow-Up Studies Heart Conduction System / physiopathology Heart Failure / blood*, physiopathology, therapy* Humans Inflammation / blood Male Middle Aged Natriuretic Peptide, Brain / blood* Neurotransmitter Agents / blood Patient Admission Predictive Value of Tests Risk Factors Systole Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Neurotransmitter Agents; 114471-18-0/Natriuretic Peptide, Brain; 9007-41-4/C-Reactive Protein |
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