Document Detail

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.
MedLine Citation:
PMID:  19493864     Owner:  NLM     Status:  MEDLINE    
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 >or= median + CRT, and 51% if >or= 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.
Rudolf Berger; Aparna Shankar; Friedrich Fruhwald; Astrid Fahrleitner-Pammer; Nick Freemantle; Luigi Tavazzi; John G F Cleland; Richard Pacher
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-06-02
Journal Detail:
Title:  European heart journal     Volume:  30     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-02     Completed Date:  2010-06-18     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2109-16     Citation Subset:  IM    
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Arrhythmias, Cardiac / blood,  therapy*
Biological Markers / metabolism
Cardiac Pacing, Artificial*
Diuretics / therapeutic use
Heart Failure / blood,  therapy*
Kaplan-Meier Estimate
Middle Aged
Natriuretic Peptide, Brain / metabolism*
Peptide Fragments / metabolism*
Spironolactone / therapeutic use
Treatment Outcome
Ventricular Dysfunction, Left / therapy*
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Biological Markers; 0/Diuretics; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 27O7W4T232/Spironolactone

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