Prognostic value of brain natriuretic peptide in the management of patients receiving cardiac resynchronization therapy

Objective: To evaluate the role of brain natriuretic peptide (BNP) in predicting the progression of heart failure (HF) after cardiac resynchronization therapy (CRT). Background: It has been shown that BNP predicts the prognosis and can guide the treatment of HE Methods: We studied 50 consecutive patients (61 +/- 10 years, 23 mate) with HF (8 with ischaemic cardiomyopathy), NYHA class III, left bundle branch block, left ventricular ejection fraction (LVEF) <= 35% (mean 24 6%) who underwent CRT. All patients were taking conventional HF therapy and were clinically stable. Plasma BNP levels were evaluated by two-site dual-monoclonal immunochemiluminescent assay before, and 1 month after CRT. The predictive value of BNP was assessed using univariate and multivariate regression analyses. Results: During follow-up (mean 19 12 months), HF progression was observed in 14 patients (11 were hospitalised and 3 died after worsening of HF). Multivariate analysis showed that BNP levels before (HR: 2.07; CI: 1. 19- 3.62; p = 0.0 1) and I month after CRT (HR: 2.23; CI: 1.26-3.94; p=0.006) were significantly related to events. At I month, a BNP level > 91.5 pg/mI had 89% sensitivity, 59% specificity, and negative and positive predictive values of 96% and 33%, respectively, for HF progression after 12 months. Conclusions: HF patients with high BNP values after 1 month of CRT have worse prognosis chning follow-up. Therefore, in these patients other therapeutic options should be considered. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.