Thorac Cardiovasc Surg 2006; 54 - PP_73
DOI: 10.1055/s-2006-925855

NT-proBNP for risk stratification after biventricular pacing in heart failure patients

A Löher 1, M Rothenburger 1, R Gradaus 2, C Vahlhaus 2, H Welp 1, G Drees 1, A Hoffmeier 1, G Hülsken 1, HH Scheld 1
  • 1Universitätsklinikum Münster, Klinik und Poliklinik für Thorax-, Herz- und Gefäßchirurgie, Münster, Germany
  • 2Universitätsklinikum Münster, Medizinische Klinik und Poliklinik C (Kardiologie/Angiologie), Münster, Germany

Objectives: The prospective study tested whether NT-proBNP levels in determining the prognosis and clinical outcome after implantation of biventricular pacing systems in heart failure patients. NT-proBNP is a marker of heart failure severity. Less is known about the impact of NT-proBNP to biventricular pacing regarding potential of recovery and outcome.

Methods: During a period of three years, 131 patients (89 male; mean age 58±15 y) with endstage heart failure and asynchrony in echocardiography were investigated. All patients received a biventricular pacing system, either PM or ICD. Levels of NT-proBNP, routine blood controls, ECG, echocardiography, and clinical examination were obtained all three months.

Results: During follow-up of 556±247 days, all patients were examined every three months. Endpoints were defined as death, transplantation or clinical benefit obtained by echocardiography and clinical examination. Five patients (3.8%) died due to worsened heart failure. Sixteen patients (12.2%) underwent reoperation due to system dysfunction. Despite biventricular pacing in fourteen patients (10.7%) heart failure severity remained worse (NYHA class III+), and NTproBNP levels high (1.800±425 pg/mL). Three and six months after surgery clinical situation markedly improved in 109 patients, including improvement of NYHA class (II) (p=0.038); ejection fraction from 21±6% to 40±8% (p=0.028), decrease of NT-proBNP levels from 4.500±526 pg/mL to 897±138 pg/mL (p=0.001).

Conclusion: NT-proBNP provided a valuable marker of clinical outcome and prognosis after biventricular pacing in heart failure patients. NT-proBNP levels remaining above 1.000 pg/mL were associated with higher rates of adverse events and less benefit after biventricular pacing regarding heart failure severity.