Significance of myeloperoxidase plasma levels as a predictor for cardiac resynchronization therapy response
Insights
Myeloperoxidase (MPO) levels significantly decrease in patients who respond to cardiac resynchronization therapy (CRT). Pre-implantation MPO levels can predict CRT response, offering a potential biomarker for treatment success in heart failure patients.
Area of Science:
- Cardiology
- Biomarkers
- Heart Failure
Background:
- Chronic heart failure (CHF) involves inflammation and oxidative stress.
- Cardiac resynchronization therapy (CRT) benefits 50-80% of CHF patients.
- Myeloperoxidase (MPO) is elevated in CHF, but its role in CRT response is unclear.
Purpose of the Study:
- To assess the correlation between myeloperoxidase (MPO) levels and response to cardiac resynchronization therapy (CRT).
- To evaluate MPO as a potential predictor of CRT response in patients with chronic heart failure.
Main Methods:
- Fifty-three patients received CRT; responders and non-responders were identified.
- MPO and NT-proBNP levels were measured pre-implantation and at 30/90 days post-implantation.
- Physical capacity, NYHA class, and LVEF were assessed at baseline and follow-up.
Main Results:
- 64% of patients responded to CRT, with responders showing decreased MPO levels (p<0.001).
- Non-responders had no significant MPO change (p=0.672).
- Baseline MPO levels (cut-off 242 ng/ml) predicted CRT response with 93.5% sensitivity and 71.4% specificity.
Conclusions:
- MPO levels correlate significantly with CRT response and differ between responders and non-responders.
- MPO may serve as a valuable predictor of CRT response in heart failure patients.
- Further randomized trials are needed to validate these findings in larger cohorts.
Objectives:
This study aimed to determine if changes in myeloperoxidase (MPO) levels correlate with response to cardiac resynchronization therapy (CRT) and the potential role of MPO as a predictor of response to CRT.
Background:
CRT is a well-established treatment option in chronic heart failure (CHF) with 50-80% of patients benefiting. Inflammation and oxidative stress play a key role in CHF pathophysiology. Previous studies have demonstrated increased levels of MPO in CHF patients, but the correlation with CRT response remains incompletely understood.
Methods:
Fifty-three patients underwent CRT implantation. During follow-up, patients were divided into two groups, responders and non-responders to CRT, based on improved physical capacity and NYHA classification. Levels of MPO and NT-pro-brain-natriuretic-peptide (NT-proBNP) were determined prior to implantation, 30 and 90 days after. Physical capacity, including a 6-min walking-test, NYHA class, and LVEF were evaluated at baseline and during follow-up.
Results:
Thirty-four patients (64%) responded to CRT, showing improved physical capacity and LVEF. All responders revealed a significant decrease of MPO levels (503.8 ng/ml vs. 188.4 ng/ml; p < 0.001). Non-responding patients did not show any significant changes in clinical parameters or MPO levels (119.6 ng/ml vs. 134.3 ng/ml; p = 0.672) during follow-up. At baseline, physical capacity and NYHA class, as well as MPO levels differed significantly between both groups (p < 0.001). A ROC analysis identified an MPO cut-off value for response to CRT of 242 ng/ml with a sensitivity of 93.5% and specificity of 71.4%. There was a strong correlation between MPO and improvement of LVEF (Spearman's rho: - 0.453; p = 0.005) and physical capacity (Spearman's rho: - 0.335; p = 0.042).
Conclusions:
Response to CRT and course of MPO levels correlate significantly. MPO levels differ between responders and non-responders prior to CRT, which may indicate an additional value of MPO as a predictor for CRT response. Further randomized studies are required to confirm our data in larger patient cohorts.
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