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Natriuretic peptide and inflammation mediators in patients with different responses to cardiac resynchronization therapy

Kuznetsov V. A., Soldatova A. M., Enina T. N., Petelina T. I.
Affiliate of the Federal State Budgetary Institution, "Research Institute of Cardiology" at the Siberian Branch of the Russian Academy of Medical Sciences, "Tyumen Cardiology Center", Melnikayte 111, Tyumen 625026

Keywords: N-terminal prohormone of brain natriuretic peptide (NT-proBNP), NT-proBNP, inflammation mediator, resynchronization therapy, CHF, EchoCG

DOI: 10.18087/rhfj.2015.2.2047

Background. Cardiac resynchronization therapy (CRT) is a current standard for the treatment of patients with severe CHF. A marker for beneficial response to CRT is being searched for. Aim. To evaluate time-related changes in levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammation mediators in patients with different responses to CRT. Materials and methods. The study included 47 patients with CHF (78.7 % men, mean age 54.5±8.7) who were implanted with CRT devices. EchoCG was performed and levels of NT-proBNP, interleukin-6 (IL-6), С-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) were measured for all patients at baseline, 12 months and 24 months of follow-up. Patients were divided into three groups based on the time-related decrease in LV end systolic volume (ESV) following the CRT device implantation: patients with LV ESV reduced by >15 % constituted the responder group (n=29; 61.7 %); patients with LV ESV reduced from 5 to 15 % constituted the non-progressor group (n=9; 19.1 %); and patients with LV ESV reduced by <5 % constituted the non-responder group (n=9; 19.1 %). Results. In the responder group, significant decreases were observed for concentrations of NT-proBNP (р=0.039; р=0.018), IL-6 (р=0.035; р=0.028), and TNF-α (р=0.035; р=0.043) throughout the entire follow-up period. The CRP level was significantly decreased at 12 months but did not differ from baseline values at 24 months of observation (р=0.034; р=0.139). In the non-progressor group, NT-proBNP was decreasing during the first years. However at 24 months, the NT-proBNP level did not significantly differ from baseline (р=0.029; р=0.477), and changes in inflammation mediators were not observed. In the non-responder group, levels of NT-proBNP and inflammation mediators did not differ from baseline values during the entire follow-up period. Conclusion. A positive response to CRT is associated with reduced neuro-humoral activity and systemic inflammation. The neuro-humoral background decreases in the first year; however, further improvement and decreases in inflammation mediators were not observed in the remote period. Probably, the complex decrease in levels of NT-proBNP and inflammation mediators can be used as a marker for a beneficial response to CRT.
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Kuznetsov V. A., Soldatova A. M., Enina T. N. et al. Natriuretic peptide and inflammation mediators in patients with different responses to cardiac resynchronization therapy. Russian Heart Failure Journal. 2015;16 (2):88–92

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