Coronary sinus biomarker sampling compared to peripheral venous blood for predicting outcomes in patients with severe heart failure undergoing cardiac resynchronization therapy: The BIOCRT study
| Autor: | James L. Januzzi, Umesh C. Sharma, Sandeep Basnet, Jackie Szymonifka, Zachary R Lavender, Wai-ee Thai, Jagmeet P. Singh, Adefolakemi Babatunde, James K. Min, Zachary Grunau, Olujimi A. Ajijola, Bryan Wai, Ryan M. Sandoval, Quynh A. Truong |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Galectin 3 medicine.medical_treatment Cardiac resynchronization therapy Risk Assessment Severity of Illness Index Article Veins Cardiac Resynchronization Therapy Predictive Value of Tests Physiology (medical) Internal medicine Natriuretic Peptide Brain medicine Humans Prospective Studies cardiovascular diseases Coronary sinus Aged Aged 80 and over Heart Failure Blood Specimen Collection Ejection fraction business.industry Coronary Sinus Venous blood Middle Aged medicine.disease Peptide Fragments Survival Rate Treatment Outcome Ventricular assist device Heart failure Predictive value of tests Cardiology Female Cardiology and Cardiovascular Medicine business Biomarkers Mace Follow-Up Studies |
| Zdroj: | Heart Rhythm. 11:2167-2175 |
| ISSN: | 1547-5271 |
| DOI: | 10.1016/j.hrthm.2014.07.007 |
| Popis: | A significant minority of patients receiving cardiac resynchronization therapy (CRT) remain nonresponsive to this intervention.This study aimed to determine whether coronary sinus (CS) or baseline peripheral venous (PV) levels of established and emerging heart failure (HF) biomarkers are predictive of CRT outcomes.In 73 patients (aged 68 ± 12 years; 83% men; ejection fraction 27% ± 7%) with CS and PV blood samples drawn simultaneously at the time of CRT device implantation, we measured amino-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble ST2 (sST2) levels. NT-proBNP concentrations2000 pg/mL, gal-3 concentrations25.9 ng/mL, and sST2 concentrations35 ng/mL were considered positive on the basis of established PV cut points for identifying "high-risk" individuals with HF. CRT response was adjudicated by the HF Clinical Composite Score. A major adverse cardiovascular event (MACE) was defined as the composite end point of death, cardiac transplant, left ventricular assist device, and HF hospitalization at 2 years.NT-proBNP concentrations were 20% higher in the CS than in the periphery, while gal-3 and sST2 concentrations were 10% higher in the periphery than in the CS (all P.001). There were 45% CRT nonresponders at 6 months and 16 (22%) patients with MACE. Triple-positive CS values yielded the highest specificity of 95% for predicting CRT nonresponse. Consistently, CS strategies identified patients at higher risk of developing MACE, with11-fold adjusted increase for triple-positive CS patients compared to triple-negative patients (all P ≤ .04). PV strategies were not predictive of MACE.Our findings suggest that CS sampling of HF biomarkers may be better than PV sampling for predicting CRT outcomes. Larger studies are needed to confirm our findings. |
| Databáze: | OpenAIRE |
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