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Effect of atrioventricular optimization on circulating N‐terminal pro brain natriuretic peptide following cardiac resynchronization therapy
Author(s) -
Shanmugam Nesan,
Campos Ana Garcia,
PradaDelgado Oscar,
Bizrah Mukhtar,
Valencia Oswaldo,
Jones Sue,
Collinson Paul,
Anderson Lisa
Publication year - 2013
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hft012
Subject(s) - medicine , interquartile range , cardiac resynchronization therapy , cardiology , heart failure , urology , biomarker , natriuretic peptide , brain natriuretic peptide , ejection fraction , biochemistry , chemistry
Aims Following CRT, atrioventricular (AV) optimization is not routinely practised. To evaluate its clinical utility, we examined the effect of AV delay optimization on the prognostic biomarker NT‐proBNP. Methods and results We prospectively studied 72 patients (mean age 73 ± 12.5 years, 70.8% male, 55.6% ischaemic) undergoing iterative AV optimization. Patients were divided into those whose nominal setting appeared ideal and not changed (Group 1, n = 22) and those whose AV delay was optimized (Group 2, n = 50). All patients underwent NT‐proBNP assessment prior to CRT, and pre‐ and a median 5 days post‐optimization. Compared with Group 1, NT‐proBNP fell significantly in Group 2 patients (median 474 pg/mL) following optimization ( P = 0.00001). A significant change in filling pattern (defined as a change in AV delay >50 ms) was required in 30% of patients, and it was this subgroup that derived the greater reduction in NT‐proBNP levels [–1407 pg/mL, interquartile range (IQR) –3042 to –346 pg/mL] compared with those requiring <50 ms AV delay change (–125 pg/mL, IQR –1038 to 6 pg/mL), P = 0.0011. The benefit of AV optimization was principally observed in reverse remodelling non‐responders (median –2167 pg/mL, IQR –3042 to –305 pg/mL) and in patients with a pseudonormal or restrictive filling pattern (median –1407 pg/mL, IQR –2809 to –342 pg/mL), compared with those with more benign diastolic filling (median – 264 pg/mL, IQR –1038 to –21 pg/mL), P = 0.033. Conclusions In one‐third of patients, major filling pattern changes are achieved with AV optimization, associated with subsequent rapid falls in NT‐proBNP. The greater the AV delay change, the larger the NT‐proBNP fall, and non‐responders and those with restrictive or pseudonormal filling despite CRT are most likely to benefit.