Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy

Abstract

Background. Cardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF). However, 30% of patients have no significant clinical or echocardiographic improvement following CRT. Reverse remodeling after CRT correlates with improved clinical outcomes. We hypothesized that in NT-pro BNP monitoring is accurate to identify responders following CRT. Methods. 42 consecutive patients (mean age 66 12 years, male 68%) with HF undergoing CRT were prospectively enrolled. Responders at follow-up were defined by echocardiography (decrease in LV end systolic volume 15%). Echocardiography and NT-pro BNP measurement were performed at baseline and repeated 3 to 6 month after CRT. Results. There was no significant difference between responders (n = 29, 69%) and non-responders (n = 13, 31%) regarding baseline NT-pro BNP level. Responders had significantly higher decrease in NT-pro BNP levels during follow-up than non-responders (absolute: -1428 1333 pg.ml-1 vs. -61 959 pg.ml-1, p = 0.002; relative: -45 28% vs. 2 28%, p < 0.0001). A decrease of 15% in NT-pro BNP 3-6 months after CRT identifies echocardiographic responders with a sensitivity of 90% and a specificity of 77%. Conclusion. NT-pro BNP monitoring can accurately identify echocardiographic responders after CRT.