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Updated: Jul 17, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Usefulness of preimplantation B-type natriuretic peptide level for predicting response to cardiac resynchronization
Nicolas Lellouche1, Carlos De Diego, David A Cesario
1UCLA Cardiac Arrhythmia Center, Los Angeles, California, USA.
Insights
Preimplantation brain natriuretic peptide (BNP) levels predict response to cardiac resynchronization therapy (CRT). Higher baseline BNP indicates a better chance of successful CRT, outperforming QRS duration in predicting outcomes for heart failure patients.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF).
- Approximately one-third of patients do not respond effectively to CRT.
- Predictive markers for CRT response are crucial for optimizing patient selection.
Purpose of the Study:
- To assess the predictive value of preimplantation brain natriuretic peptide (BNP) levels for CRT response.
- To compare the efficacy of BNP with QRS duration in predicting CRT outcomes.
Main Methods:
- Retrospective analysis of 164 patients with advanced HF undergoing CRT.
- Inclusion criteria: NYHA class III/IV, LVEF ≤35%, QRS duration >130 ms, no inotropic support.
- CRT response defined as absence of HF hospitalization and ≥1 NYHA class improvement at 6 months.
Main Results:
- Higher preimplantation BNP levels were observed in CRT responders (800 ± 823 pg/ml) versus non-responders (335 ± 348 pg/ml).
- Preimplantation BNP was the sole independent predictor of CRT response (p=0.001).
- A BNP threshold of ≥447 pg/ml showed 62% sensitivity and 79% specificity for predicting response.
Conclusions:
- Preimplantation BNP levels are an independent predictor of CRT response in heart failure patients.
- BNP is superior to QRS duration reduction in identifying patients likely to benefit from CRT.
- Elevated preimplantation BNP may indicate intraventricular dyssynchrony, further supporting its predictive role.
Abstract:
Nearly 1/3 of patients with heart failure (HF) fail to respond to cardiac resynchronization therapy (CRT). The purpose of this study was to evaluate the value of preimplantation brain natriuretic peptide (BNP) in predicting the clinical response to CRT. We retrospectively analyzed 164 patients who underwent CRT. Patients with New York Heart Association functional class III or IV HF symptoms despite maximal medical therapy, who were not on inotropic medications, had left ventricular ejection fraction < or =35%, and QRS duration >130 ms were included in the study. CRT response in patients who survived at 6-month follow-up was defined as no HF hospitalization and improvement of > or =1 grades in the New York Heart Association classification. BNP assays were performed before implantation and at 6-month follow-up. Patients had ischemic (47%) or nonischemic (53%) cardiopathy. Responders (n = 107) and nonresponders (n = 57) had similar baseline characteristics. Cardiac death and hospitalization for HF occurred in 5 (4.7%) and 18 (31.6%) patients, respectively. CRT responders compared with nonresponders exhibited higher preimplantation BNP levels (800 +/- 823 vs 335 +/- 348 pg/ml, p = 0.0002) and a significant reduction in the QRS duration after implantation (-6 +/- 34 vs +7 +/- 32 ms, p = 0.048). The preimplantation BNP was the only independent predictor of the CRT response (p = 0.001). A BNP value > or =447 pg/ml demonstrated a sensitivity of 62% and specificity of 79% in identifying CRT response. In a subgroup of 41 patients who underwent Doppler tissue imaging analysis, the preimplantation BNP was higher in patients presenting with intraventricular dyssynchrony (845 +/- 779 vs 248 +/- 290 pg/ml, p = 0.04). In conclusion, the preimplantation BNP value independently predicts CRT response and was superior to QRS duration reduction in identifying CRT responders.
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