Truong Quynh A, Januzzi James L, Szymonifka Jackie, Thai Wai-ee, Wai Bryan, Lavender Zachary, Sharma Umesh, Sandoval Ryan M, Grunau Zachary S, Basnet Sandeep, Babatunde Adefolakemi, Ajijola Olujimi A, Min James K, Singh Jagmeet P
Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Heart Rhythm. 2014 Dec;11(12):2167-75. doi: 10.1016/j.hrthm.2014.07.007. Epub 2014 Jul 8.
A significant minority of patients receiving cardiac resynchronization therapy (CRT) remain nonresponsive to this intervention.
This study aimed to determine whether coronary sinus (CS) or baseline peripheral venous (PV) levels of established and emerging heart failure (HF) biomarkers are predictive of CRT outcomes.
In 73 patients (aged 68 ± 12 years; 83% men; ejection fraction 27% ± 7%) with CS and PV blood samples drawn simultaneously at the time of CRT device implantation, we measured amino-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble ST2 (sST2) levels. NT-proBNP concentrations >2000 pg/mL, gal-3 concentrations >25.9 ng/mL, and sST2 concentrations >35 ng/mL were considered positive on the basis of established PV cut points for identifying "high-risk" individuals with HF. CRT response was adjudicated by the HF Clinical Composite Score. A major adverse cardiovascular event (MACE) was defined as the composite end point of death, cardiac transplant, left ventricular assist device, and HF hospitalization at 2 years.
NT-proBNP concentrations were 20% higher in the CS than in the periphery, while gal-3 and sST2 concentrations were 10% higher in the periphery than in the CS (all P < .001). There were 45% CRT nonresponders at 6 months and 16 (22%) patients with MACE. Triple-positive CS values yielded the highest specificity of 95% for predicting CRT nonresponse. Consistently, CS strategies identified patients at higher risk of developing MACE, with >11-fold adjusted increase for triple-positive CS patients compared to triple-negative patients (all P ≤ .04). PV strategies were not predictive of MACE.
Our findings suggest that CS sampling of HF biomarkers may be better than PV sampling for predicting CRT outcomes. Larger studies are needed to confirm our findings.
接受心脏再同步治疗（CRT）的患者中有相当一部分对该干预措施无反应。
本研究旨在确定已确立和新出现的心力衰竭（HF）生物标志物的冠状窦（CS）或基线外周静脉（PV）水平是否可预测CRT结果。
在73例患者（年龄68±12岁；83%为男性；射血分数27%±7%）中，在CRT设备植入时同时采集CS和PV血样，我们测量了氨基末端B型利钠肽原（NT-proBNP）、半乳糖凝集素-3（gal-3）和可溶性ST2（sST2）水平。根据已确立的用于识别HF“高危”个体的PV切点，NT-proBNP浓度>2000 pg/mL、gal-3浓度>25.9 ng/mL和sST2浓度>35 ng/mL被视为阳性。CRT反应通过HF临床综合评分判定。主要不良心血管事件（MACE）定义为2年时死亡、心脏移植、左心室辅助装置和HF住院的复合终点。
CS中的NT-proBNP浓度比外周高20%，而gal-3和sST2浓度在外周比CS高10%（均P<.001）。6个月时45%的患者对CRT无反应，16例（22%）患者发生MACE。三联阳性CS值对预测CRT无反应的特异性最高，为95%。一致地，CS策略识别出发生MACE风险较高的患者，三联阳性CS患者与三联阴性患者相比，调整后增加超过11倍（均P≤.04）。PV策略不能预测MACE。
我们的研究结果表明，HF生物标志物的CS采样在预测CRT结果方面可能优于PV采样。需要更大规模的研究来证实我们的发现。
