Echocardiographic optimization of cardiac resynchronization
therapy device contributes to a greater reduction of heart failure biomarker compared to the electrocardiographic method

    Authors

    Keywords

    cardiac resynchronization therapy, NTproBNP

    DOI

    https://doi.org/10.15836/ccar2022.258

    Full Text

    **Introduction**: Resynchronization therapy is an effective method for treating advanced heart failure that contributes to echocardiographic, clinical and laboratory favorable outcomes. (1-4) This study was aimed to compare the dynamics in the reduction of heart failure biomarker (NTproBNP) between two groups of patients whose resynchronization device (CRT) was optimized by a) echocardiographic and b) electrocardiographic method. **Patients and Methods**: A total of 146 patients with implanted CRT according to the guidelines for resynchronization therapy were included in this randomized study. The examined population was divided into two groups depending on the method used for CRT optimization. In the first group (US) the echocardiographic method was used, correcting the parameters of cardiac mechanical dyssynchrony, and in the second group (ECG) an electrocardiographic method that corrects the parameters of CRT according to QRS width. NTproBNP values were determined before and 6 months after the implantation of CRT and compared with each other. **Results**: The results are shown in **Figure 1**. In both groups there was a significant reduction in NTproBNP (p<0.001) over a period of 6 months, but in the US group this decrease was even more significant (p=0.037). FIGURE 1. **Difference in NT-proBNP reduction between the echocardiographic and electrocardiographic optimization groups.** NTproBNP - N-terminal pro B-type natriuretic peptide; CRT = cardiac resynchronization therapy; US = echocardiography group; ECG = electrocardiography group **Conclusion**: Echocardiographic optimization of CRT leads to a significant decrease in NTproBNP compared to electrocardiographic optimization over a period of six months.

    Literature

    1. Bakos Z, Chatterjee NC, Reitan C, Singh JP, Borgquist R. Prediction of clinical outcome in patients treated with cardiac resynchronization therapy - the role of NT-ProBNP and a combined response score. BMC Cardiovasc Disord. 2018 April 24;18(1):70. https://doi.org/10.1186/s12872-018-0802-8
    2. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005 April 14;352(15):1539–49. https://doi.org/10.1056/NEJMoa050496
    3. Pujol-López M, San Antonio R, Mont L, Trucco E, Tolosana JM, Arbelo E, et al. Electrocardiographic optimization techniques in resynchronization therapy. Europace. 2019 September 1;21(9):1286–96. https://doi.org/10.1093/europace/euz126
    4. Roubicek T, Stros J, Kucera P, Nedbal P, Cerny J, Polasek R, et al. Combination of left ventricular reverse remodeling and brain natriuretic peptide level at one year after cardiac resynchronization therapy predicts long-term clinical outcome. PLoS One. 2019 July 17;14(7):e0219966. https://doi.org/10.1371/journal.pone.0219966
    Cardiologia Croatica
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    Echocardiographic optimization of cardiac resynchronization
therapy device contributes to a greater reduction of heart failure biomarker compared to the electrocardiographic method

    Extended Abstract
    Issue9-10
    Published
    Pages258
    PDF via DOIhttps://doi.org/10.15836/ccar2022.258
    cardiac resynchronization therapy
    NTproBNP

    Authors

    Marija Brestovac*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Martina Lovrić BenčićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Blanka Glavaš KonjaORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Sandra Jakšić JurinjakORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Kristina GašparovićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Zvonimir OstojićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Joško BulumORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    *Correspondence email: marija.brestovac@gmail.com

    Full Text

    Introduction: Resynchronization therapy is an effective method for treating advanced heart failure that contributes to echocardiographic, clinical and laboratory favorable outcomes. (1–4) This study was aimed to compare the dynamics in the reduction of heart failure biomarker (NTproBNP) between two groups of patients whose resynchronization device (CRT) was optimized by a) echocardiographic and b) electrocardiographic method.

    Patients and Methods: A total of 146 patients with implanted CRT according to the guidelines for resynchronization therapy were included in this randomized study. The examined population was divided into two groups depending on the method used for CRT optimization. In the first group (US) the echocardiographic method was used, correcting the parameters of cardiac mechanical dyssynchrony, and in the second group (ECG) an electrocardiographic method that corrects the parameters of CRT according to QRS width. NTproBNP values were determined before and 6 months after the implantation of CRT and compared with each other.

    Results: The results are shown in Figure 1. In both groups there was a significant reduction in NTproBNP (p<0.001) over a period of 6 months, but in the US group this decrease was even more significant (p=0.037).

    FIGURE 1. Difference in NT-proBNP reduction between the echocardiographic and electrocardiographic optimization groups. NTproBNP - N-terminal pro B-type natriuretic peptide; CRT = cardiac resynchronization therapy; US = echocardiography group; ECG = electrocardiography group

    Conclusion: Echocardiographic optimization of CRT leads to a significant decrease in NTproBNP compared to electrocardiographic optimization over a period of six months.

    Literature

    1. 1.
      Bakos Z, Chatterjee NC, Reitan C, Singh JP, Borgquist R. Prediction of clinical outcome in patients treated with cardiac resynchronization therapy - the role of NT-ProBNP and a combined response score. BMC Cardiovasc Disord. 2018 April 24;18(1):70.DOI
    2. 2.
      Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005 April 14;352(15):1539–49.DOI
    3. 3.
      Pujol-López M, San Antonio R, Mont L, Trucco E, Tolosana JM, Arbelo E, et al. Electrocardiographic optimization techniques in resynchronization therapy. Europace. 2019 September 1;21(9):1286–96.DOI
    4. 4.
      Roubicek T, Stros J, Kucera P, Nedbal P, Cerny J, Polasek R, et al. Combination of left ventricular reverse remodeling and brain natriuretic peptide level at one year after cardiac resynchronization therapy predicts long-term clinical outcome. PLoS One. 2019 July 17;14(7):e0219966.DOI