Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
J Cardiol. 2022 Jun;79(6):727-733. doi: 10.1016/j.jjcc.2021.12.015. Epub 2022 Jan 10.
Biomarkers that can predict cardiac resynchronization therapy (CRT) response have not yet been identified. The purpose of this study was to assess whether individual measurements of four brain/B-type natriuretic peptide (BNP) forms, coupled with cyclic guanosine monophosphate (cGMP) might contribute to the prediction of echocardiographic CRT responders.
A BNP precursor (proBNP) and total BNP (= proBNP + mature BNP) were measured with newly developed kits, while an N-terminal fragment of proBNP (NT-proBNP) and cGMP were measured with commercial kits on the day before CRT implantation. Estimated mature BNP (emBNP = total BNP-proBNP), and the ratio of cGMP to each BNP form, as well as the concentrations of three other BNP forms, were prospectively investigated for their capability in predicting a response to CRT. A CRT responder was defined as an improvement in left ventricular ejection fraction >10% and/or a reduction in left ventricular end-systolic volume >15% at 6-month follow-up.
Out of 77 patients, 46 (60%) were categorized as CRT responders. Among the measurement parameters, only the highest quartile of the cGMP to emBNP ratio was an independent predictor of CRT responders (odds ratio 4.87, 95% confidence interval 1.25-18.89, p = 0.02). The cGMP to emBNP ratio was associated with the cumulative events of heart failure hospitalization within one year following CRT implantation (log-rank p = 0.029).
The cGMP to emBNP ratio could be utilized as a predictive biomarker of CRT responders. (Clinical Study on Responder Prediction in Cardiac Resynchronization Therapy Using Individual Molecular Measurement of Natriuretic Peptide: UMIN R000038927).
目前尚未发现能够预测心脏再同步治疗（CRT）反应的生物标志物。本研究旨在评估四个脑/B 型利钠肽（BNP）形式的个体测量值，加上环鸟苷单磷酸（cGMP）是否有助于预测超声心动图 CRT 反应者。
使用新开发的试剂盒测量 BNP 前体（proBNP）和总 BNP（= proBNP + 成熟 BNP），而使用商业试剂盒在 CRT 植入前一天测量 proBNP 的 N 端片段（NT-proBNP）和 cGMP。前瞻性研究了估计的成熟 BNP（emBNP = 总 BNP-proBNP）以及 cGMP 与每种 BNP 形式的比值，以及其他三种 BNP 形式的浓度，以评估其预测 CRT 反应的能力。CRT 反应者定义为 6 个月随访时左心室射血分数改善>10%和/或左心室收缩末期容积减少>15%。
在 77 名患者中，46 名（60%）被归类为 CRT 反应者。在测量参数中，只有 cGMP 与 emBNP 比值的最高四分位数是 CRT 反应者的独立预测因子（优势比 4.87，95%置信区间 1.25-18.89，p=0.02）。cGMP 与 emBNP 比值与 CRT 植入后一年内心力衰竭住院的累积事件相关（对数秩检验 p=0.029）。
cGMP 与 emBNP 比值可作为 CRT 反应者的预测生物标志物。（心脏再同步治疗反应预测的临床研究：使用利钠肽个体分子测量）。
