Veli Polat1, Gonul Aciksari2

1Bakirkoy Dr. Sadi Konuk Training And Research Hospital, Department Of Cardiology, Istanbul, Turkey
2Istanbul Medeniyet University Goztepe Training And Research Hospital, Department Of Cardiology, Istanbul, Turkey

Keywords: cardiac resynchronization therapy; heart failure; adiponectin, nt-probnp; mr-proanp

Abstract

Objectives: Cardiac resynchronization therapy (CRT), is a therapeutic option for patients with refractory heart failure. We aimed to examine the usefulness of N-terminal pro-brain-type natriuretic peptide (NT-proBNP), mid-regional pro-atrial natriuretic peptide (MR-proANP), and adiponectin in monitoring CRT-induced left ventricular (LV) reverse remodeling, reverse electrical remodeling, and clinical response.

Patients and Methods: We prospectively enrolled 46 heart failure patients who underwent clinical, electrocardiographic, echocardiographic evaluation and blood sampling for measurements of NT-proBNP, MR-proANP, and adiponectin before and 12-months after CRT implantation. LV reverse remodeling (LVRR), reverse electrical remodeling (RER) and clinical response were described respectively as a decrease in LV end-systolic volume (LVESV) ≥15% or an absolute increase in LV ejection fraction ≥ 5%, a decrease in intrinsic QRS (iQRS) duration by ≥20 ms, and an improvement of NYHA ≥1 class.

Results: At 12 months, LV function, and size, severity of mitral regurgitation (MR), clinical status, and QRS duration were significantly improved by CRT. We detected LVRR, RER, and clinical response in 72%, 54%, and 76% of patients, respectively. Both reductions in MR-proANP and adiponectin levels were correlated with decrease in LVESV (r=0.51, p<0.05; r=0.50, p < 0.05, respectively). Also, there was an association between reduction in MR-proANP levels and decrease in mitral regurgitation grade (r=0.50, p <0.05). We observed a relationship between decrease in iQRS duration and reduction in MR-proANP levels after CRT (r=0.67, p <0.05).

Conclusion: MR-proANP levels after CRT may reflect electrical response and regression in MR. Furthermore, both adiponectin and MR-proANP levels after CRT may reveal decrease in LVESV.