Veli Polat1, Gönül Açıksarı2

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

Keywords: Cardiac resynchronization therapy; heart failure; adiponectin, NT-proBNP; MR-proANP.


Introduction: 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, MRproANP, 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.

Ethics Committee Approval

The present was approved by the Local Ethics Committee on 23.11.2015 with the decision number 2015/147. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013.

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - VP; Analysis/Interpretation - VP, GA; Data Collection - VP, GA; Writing - VP; Critical Revision - VP, GA; Statistical Analysis - VP, GA; Overall Responsibility - VP, GA; Final Approval - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

This study was funded by Ibrahim Etem Menarini Group.