Kamoshida Junichi, Ueda Nobuhiko, Ishibashi Kohei, Noda Takashi, Kawabata Takanori, Oka Satoshi, Miyazaki Yuichiro, Wakamiya Akinori, Nakajima Kenzaburo, Kamakura Tsukasa, Wada Mitsuru, Inoue Yuko, Miyamoto Koji, Nagase Satoshi, Aiba Takeshi, Kanzaki Hideaki, Izumi Chisato, Noguchi Teruo, Kusano Kengo
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Osaka Japan.
Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan.
Circ Rep. 2024 Sep 14;6(10):407-414. doi: 10.1253/circrep.CR-24-0065. eCollection 2024 Oct 10.
Patients who achieve improved left ventricular ejection fraction (LVEF >35%) with cardiac resynchronization therapy (CRT) are at a lower risk of ventricular arrhythmia (VA). Little is known about the significance of the B-type natriuretic peptide (BNP) level for the risk of VA. This study investigated the risk factors for VA in CRT and the risk stratification of VA with BNP in CRT with improved LVEF.
This study evaluated 352 CRT patients from 2012 to 2020. Patients were categorized into 2 groups: improved LVEF (impEF; LVEF >35%), and low LVEF (lowEF; LVEF ≤35%). The serum BNP levels 6 months after CRT device implantation were measured. The primary endpoint was defined as VA requiring treatment with anti-tachycardia pacing or shock or persisting for ≥30 s. Overall, 102 patients had improved LVEF. The impEF group had a significantly lower VA risk than the lowEF group. Patients with low BNP had a lower VA risk than those with high BNP; however, no significant difference was observed between patients with high BNP and those in the lowEF group. Univariate analysis revealed that high BNP was a predictor of VA in the impEF group.
The VA risk is reduced with improved LVEF after CRT but not with high BNP levels. The post-BNP level after CRT implantation is a useful marker for predicting VA in patients with improved LVEF.
通过心脏再同步治疗（CRT）使左心室射血分数提高（LVEF>35%）的患者发生室性心律失常（VA）的风险较低。关于B型利钠肽（BNP）水平对VA风险的意义知之甚少。本研究调查了CRT中VA的危险因素以及BNP对LVEF改善的CRT患者VA的风险分层。
本研究评估了2012年至2020年的352例CRT患者。患者分为两组：LVEF改善组（impEF；LVEF>35%）和LVEF低组（lowEF；LVEF≤35%）。测量CRT设备植入后6个月的血清BNP水平。主要终点定义为需要抗心动过速起搏或电击治疗或持续≥30秒的VA。总体而言，102例患者的LVEF得到改善。impEF组的VA风险显著低于lowEF组。BNP低的患者比BNP高的患者VA风险更低；然而，BNP高的患者与lowEF组患者之间未观察到显著差异。单因素分析显示，高BNP是impEF组VA的预测因素。
CRT后LVEF改善可降低VA风险，但BNP水平升高则不能。CRT植入后BNP水平是预测LVEF改善患者VA的有用标志物。
