NT-proBNP, MR-proANP and Adiponectin Levels in Monitoring Cardiac Resynchronization Therapy

Abstract

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.