Long-Term Outcome after Cardiac Resynchronization Therapy Is Related to the Time-Related Change of Brain Natriuretic Peptide at Midterm Follow-Up

Background: High brain natriuretic peptide (BNP) level was known as a predictor of clinical outcomes in patients receiving cardiac resynchronization therapy with defibrillator (CRT-D). However the assessment of CRT-D for patients with lower BNP has not been firmly established. The purpose of this study was to evaluate the relation between the time-related change of BNP and the clinical response to CRT-D in patients with lower BNP. Methods: We studied consecutive 52 advanced HF patients (lower BNP level (<500 pg/ml), 321±226 pg/ml, NYHA class 3.3±0.8, left ventricular ejection fraction 29±9%, QRS duration 164±30 ms, 44 males). BNP level was measured each 3 month after implantation until 12 months. We defined 2 BNP groups (Group 1, n=39; decreased or did not change. Group 2, n=12; increased). The end point was all-cause mortality or HF hospitalization. Results: During a mean follow-up of 937±647 days, 15 deaths and 18 HF hospitalization were observed. Baseline BNP level was not related to the clinical outcomes. During a follow-up, the clinical event-free survival rate was 78% in group 1 compared with 11% in group 2 (log-rank p value<0.001). Conclusions: The BNP time-related change at midterm follow-up, but not baseline BNP, is predictive for long-term outcome in CRT-D in patients with lower BNP.