Interventricular lead separation is critical for NT-proBNP reduction after cardiac resynchronization therapy

Lang, N. N. , Badar, A. A., Pettit, S. J., Templeton, S., Connelly, D. T. and Gardner, R. S. (2014) Interventricular lead separation is critical for NT-proBNP reduction after cardiac resynchronization therapy. Biomarkers in Medicine, 8(6), pp. 797-806. (doi: 10.2217/BMM.13.159) (PMID:25224936)

Abstract

Cardiac resynchronization therapy (CRT) is an established therapy for selected patients with chronic heart failure, severe left ventricular systolic dysfunction and prolongation of the surface QRS complex. It is provides morbidity and mortality benefits, as well as improvements in measures of left ventricular performance. However, these effects are not uniform and between 20-40% do not derive any discernible benefit from the procedure. While selection of appropriate patients to receive CRT is clearly of major importance to maximize benefit procedural factors are also implicated. For example, placement of the left ventricular lead (LV) in an apical position is associated with inferior outcome. Achieving the maximum separation between left and right ventricular (RV) pacing electrodes is theoretically attractive for biventricular pacing and cardiac resynchronization to allow coordinated contraction across the widest possible myocardial volume from the site of the greatest electromechanical delay. Indeed, greater LV-RV lead separation has been associated with improved acute hemodynamic responses, electrical surrogates, left ventricular remodeling and clinical response as assessed by New York Heart Association (NYHA) class. The definition of response to CRT is controversial and device therapy is associated with a large placebo effect that confounds symptomatic assessment. NT-proBNP is a useful marker of response to therapies and as a marker of prognosis in patients with heart failure, including those receiving CRT. The pathophysiological role of natriuretic peptides and their clinical utility have been recently reviewed. Therefore, we assessed the relationship between 3D radiographic lead separation and change in NT-proBNP in patients undergoing CRT.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Gardner, Professor Roy and Lang, Professor Ninian and Connelly, Dr Derek
• Authors: Lang, N. N., Badar, A. A., Pettit, S. J., Templeton, S., Connelly, D. T., and Gardner, R. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Biomarkers in Medicine
• Publisher: Future Medicine Ltd.
• ISSN: 1752-0363
• ISSN (Online): 1752-0371