• Andrew Brenyo, Alon Barsheshet, Mohan Rao, David T Huang, Wojciech Zareba, Scott McNitt, W Jackson Hall, Derick R Peterson, Scott D Solomon, Arthur J Moss, and Ilan Goldenberg.
• Division of Cardiology, and the Department of Biostatistics, University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
• Circ Heart Fail. 2013 Sep 1; 6 (5): 998-1004.

BackgroundThere are limited data on the prognostic implications of brain natriuretic peptide (BNP) assessment in patients with mildly symptomatic heart failure (HF) who receive cardiac resynchronization therapy with a defibrillator (CRT-D).Methods And ResultsThe effect of elevated baseline and 1-year BNP levels (dichotomized at the upper tertile BNP of 120 pg/mL) on the risk of HF or death was assessed among the cohort of 1197 patients with baseline BNP data enrolled in MADIT (Multicenter Automated Defibrillator Implantation Trial)-CRT. Elevated baseline BNP was associated with a significant 68% (P=0.007) and 58% (P=0.02) increase in the risk of HF or death among MADIT-CRT patients allocated to CRT-D and implantable cardioverter defibrillator-only therapy, respectively. At 1 year of follow-up, patients allocated to CRT-D displayed significantly greater reductions in BNP (26% reduction) levels compared with implantable cardioverter defibrillator-only patients (8% increase; P=0.005). Patients with CRT-D in whom 1-year BNP levels were reduced or remained low experienced a significantly lower risk of subsequent HF or death as compared with patients in whom 1-year BNP levels were high. Similarly, the echocardiographic response to CRT-D was highest among those who maintained low BNP levels or in whom BNP level at 1-year was reduced.ConclusionsOur findings suggest that assessment of baseline and follow-up BNP provides important prognostic implications in patients with mildly symptomatic HF who receive CRT.

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