PMID- 19816874
OWN - NLM
STAT- MEDLINE
DCOM- 20100204
LR  - 20220330
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Print)
IS  - 0160-9289 (Linking)
VI  - 32
IP  - 11
DP  - 2009 Nov
TI  - Usefulness of brain natriuretic peptide level at implant in predicting mortality 
      in patients with advanced but stable heart failure receiving cardiac 
      resynchronization therapy.
PG  - E33-8
LID - 10.1002/clc.20490 [doi]
AB  - BACKGROUND: Brain natriuretic peptide (BNP) level has emerged as a predictor of 
      death and hospital readmission in patients with heart failure (HF). The value of 
      baseline BNP assessment in advanced HF patients receiving cardiac 
      resynchronization defibrillator therapy (CRT-D) has not been firmly established. 
      HYPOTHESIS: We hypothesized that a baseline BNP level would predict all cause 
      mortality and HF hospitalization in HF patients receiving cardiac 
      resynchronization therapy. METHODS: A retrospective chart review of all patients 
      having BNP assessment prior to implantation of a CRT-D for standard indications 
      during 2004 and 2005 was conducted at the Veterans Affairs Pittsburgh Healthcare 
      System. The primary endpoint was all-cause mortality and the secondary endpoint 
      was HF-related hospitalization. We used findings from the receiver operating 
      characteristic (ROC) curve to define low (<492 pg/mL) and high (> or =492 pg/mL) 
      BNP groups. RESULTS: Out of 173 CRT-D recipients, 115 patients (mean age 67.0 +/- 
      10.7 years, New York Heart Association [NYHA] class 2.9 +/- 0.3, left ventricular 
      ejection fraction [LVEF] 22.5% +/- 9.6%, QRS 148.3 +/- 30.4 ms) had 
      preimplantation BNP measured (mean 559 +/- 761 pg/mL and median 315 pg/mL). 
      During a mean follow-up time of 17.5 +/- 6.5 mo, 27 deaths (23.5%) and 31 HF 
      hospitalizations (27.0%) were recorded. Compared to those with low BNP (n = 74), 
      those of high BNP (n = 41) were older, had lower LVEF, higher creatinine levels, 
      suffered more deaths, and HF hospitalizations. In multivariate regression models, 
      higher BNP remained a significant predictor of both the primary endpoint (hazard 
      ratio [HR]: 2.89, 95% confidence interval [CI] 1.06-7.88, p = 0.038) and 
      secondary endpoint (HR: 4.23, 95% CI: 1.68-10.60, p = 0.002). CONCLUSIONS: 
      Baseline BNP independently predicted mortality and HF hospitalization in a 
      predominantly older white male population of advanced HF patients receiving 
      CRT-D. Elevated BNP levels may identify a vulnerable HF population with a 
      particularly poor prognosis despite CRT-D.
FAU - El-Saed, Aiman
AU  - El-Saed A
AD  - Graduate School of Public Health, University of Pittsburgh, PA 15240, USA.
FAU - Voigt, Andrew
AU  - Voigt A
FAU - Shalaby, Alaa
AU  - Shalaby A
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Biomarkers)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged
MH  - Biomarkers/blood
MH  - Defibrillators, Implantable
MH  - Electric Countershock/instrumentation/*mortality
MH  - Female
MH  - Heart Failure/blood/*mortality/*therapy
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*blood
MH  - Patient Readmission
MH  - Predictive Value of Tests
MH  - Proportional Hazards Models
MH  - ROC Curve
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Up-Regulation
PMC - PMC6653145
EDAT- 2009/10/10 06:00
MHDA- 2010/02/05 06:00
PMCR- 2009/10/08
CRDT- 2009/10/10 06:00
PHST- 2009/10/10 06:00 [entrez]
PHST- 2009/10/10 06:00 [pubmed]
PHST- 2010/02/05 06:00 [medline]
PHST- 2009/10/08 00:00 [pmc-release]
AID - CLC20490 [pii]
AID - 10.1002/clc.20490 [doi]
PST - ppublish
SO  - Clin Cardiol. 2009 Nov;32(11):E33-8. doi: 10.1002/clc.20490.