Association of BNP and Troponin Levels with Outcome among Cardiac Resynchronization Therapy Recipients

Autor:	Gregg C. Fonarow, Jasmina Halilovic, William T. Abraham, Samir Saba, Jagmeet P. Singh, Alaa Shalaby, Ali Sonel, Malcolm M. Bersohn, Alan Maisel, Li-Yin Lee, John Gorcsan, Alan Kadish
Rok vydání:	2015
Předmět:	medicine.medical_specialty Ischemic cardiomyopathy Ejection fraction biology Proportional hazards model business.industry medicine.medical_treatment Hazard ratio Cardiac resynchronization therapy General Medicine medicine.disease Troponin Confidence interval Heart failure Internal medicine cardiovascular system medicine biology.protein Cardiology cardiovascular diseases Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 38:581-590
ISSN:	0147-8389
DOI:	10.1111/pace.12610
Popis:	Background We conducted a prospective multicenter study to assess the prognostic value of combined baseline preimplant plasma levels of the biomarkers cardiac troponin T (TnT) and B-type natriuretic peptide (BNP) among cardiac resynchronization therapy (CRT) with or without defibrillator capability (CRT-D) recipients. Methods At CRT-D implant, patients were stratified based on detectable TnT (≥0.01 ng/mL) and elevated BNP (predefined as >440 pg/mL) levels. Patients were classified into three groups: high (both detectable TnT and high BNP), intermediate (either detectable TnT or high BNP), or low (nondetectable TnT and low BNP). Patients were followed for 12 months. Survival curves free from mortality or heart failure hospitalizations (HFH) were assessed. To assess the predictive value of biomarker category, we constructed a multivariate Cox regression model, including the covariates of age, New York Heart Association class, left ventricular ejection fraction (LVEF), and QRS duration. Results A total of 267 patients (age 66 ± 12 years, males 80%, LVEF 25% ± 8%, ischemic cardiomyopathy 52%, QRSd 155 ± 26 ms) were studied. After 1 year, there were 13 deaths and 25 HFH events. A significant difference in event-free survival among the three groups was observed, with high and intermediate categories having worse survival than low (log-rank test, P < 0.001). In the multivariate model, risk category was a significant predictor of outcome: hazard ratios were 7.34 (95% confidence interval [CI]: 2.48–21.69) and 2.50 (95% confidence interval [CI]: 1.04–6.04) for high-risk and intermediate-risk groups, respectively (P < 0.0001). Conclusion Among CRT-D recipients, baseline TnT and BNP values alone or in combination provide significant prognostic value for the outcome of mortality or HFH.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::a0a99626e480666ac18056f252476e3f https://doi.org/10.1111/pace.12610 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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