Yu Cheuk-Man, Fung Jeffrey Wing-Hong, Zhang Qing, Chan Chi-Kin, Chan Iris, Chan Yat-Sun, Kong Shun-Ling, Sanderson John E, Lam Christopher Wai-Kei
Department of Medicine and Therapeutics, Division of Cardiology, The Chinese University of Hong Kong.
J Card Fail. 2005 Jun;11(5 Suppl):S42-6. doi: 10.1016/j.cardfail.2005.04.007.
Cardiac resynchronization therapy (CRT) is now an established therapy for patients with advanced heart failure with electromechanical delay, although nonresponders have been observed. Because natriuretic peptides are relevant markers to reflect the severity of heart failure and filling pressure of cardiac chambers, it may be helpful to assess the efficacy of CRT.
Forty-two patients with heart failure with QRS of >120 msec were recruited; their serial N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured at baseline and at 1 and 3 months after CRT. There was a reduction in NT-proBNP level 1 month after CRT (2655 +/- 2242 pg/mL vs 2149 +/- 2033 pg/mL; P = .03), which was further reduced at 3 months (1473 +/- 1786 pg/mL; P < .001 vs baseline). The reduction of NT-proBNP correlated with the change of left ventricular (LV) end-systolic volume (r = 0.53; P = .001) or LV ejection fraction ( r = -0.49; P = .002) and with improvement in exercise capacity after CRT for 3 months (r = 0.50; P = .002). The patients were classified by the degree of reduction in NT-proBNP as group 1 (reduction of > or =50% vs baseline; n = 19) and group 2 (reduction of <50% vs baseline; n = 23). The degree of LV reverse remodeling (-31.8 +/- 24.7 mL vs -12.6 +/- 19.2 mL; P = .007) and gain in LV ejection fraction (+12.5% +/- 8.8% vs +4.6% +/- 5.8%; P = .002) were significantly better in group 1 than group 2. Both the all-cause mortality rate (Log-rank chi 2 = 4.01; P = .04) and the composite end-point of mortality rate or hospitalization rate for cardiovascular causes (Log-rank chi 2 = 4.31; P = .02) were significantly lower in group 1 than in group 2.
Serial monitoring of NT-proBNP may be helpful to predict a favorable outcome after CRT. Those who had a reduction of NT-proBNP level of >/=50% were more likely to exhibit a favorable response.
心脏再同步治疗（CRT）现已成为治疗伴有电机械延迟的晚期心力衰竭患者的既定疗法，尽管已观察到有无反应者。由于利钠肽是反映心力衰竭严重程度和心腔充盈压的相关标志物，因此评估CRT的疗效可能会有所帮助。
招募了42例QRS时限>120毫秒的心力衰竭患者；在基线时以及CRT后1个月和3个月测量他们的系列N末端B型利钠肽原（NT-proBNP）水平。CRT后1个月NT-proBNP水平降低（2655±2242 pg/mL对2149±2033 pg/mL；P = 0.03），3个月时进一步降低（1473±1786 pg/mL；与基线相比P <0.001）。NT-proBNP的降低与左心室（LV）收缩末期容积的变化（r = 0.53；P = 0.001）或LV射血分数（r = -0.49；P = 0.002）相关，并且与CRT治疗3个月后的运动能力改善相关（r = 0.50；P = 0.002）。根据NT-proBNP的降低程度将患者分为1组（较基线降低≥50%；n = 19）和2组（较基线降低<50%；n = 23）。1组的LV逆向重构程度（-31.8±24.7 mL对-12.6±19.2 mL；P = 0.007）和LV射血分数增加（+12.5%±8.8%对+4.6%±5.8%；P = 0.002）明显优于2组。1组的全因死亡率（对数秩检验χ2 = 4.01；P = 0.04）以及心血管原因导致的死亡率或住院率的复合终点（对数秩检验χ2 = 4.31；P = 0.02）均明显低于2组。
连续监测NT-proBNP可能有助于预测CRT后的良好结局。NT-proBNP水平降低≥50%的患者更有可能表现出良好反应。
