Abstract 17390: Novel Heart Failure Biomarkers Predict Improvement of Mitral Regurgitation in Patients Receiving Cardiac Resynchronization Therapy_The BIOCRT Study
Introduction: Cardiac resynchronization therapy (CRT) patients with improved functional mitral regurgitation (MR) have better clinical outcomes, though a significant proportion still have residual MR. We hypothesized that heart failure (HF) biomarkers (amino-terminal pro-B type natriuretic peptide [NT-proBNP, myocardial stretch], high-sensitivity troponin [hsTnI, myonecrosis], galectin 3 [gal-3, fibrosis] and soluble ST-2 [sST2, stress/fibrotic/remodelling]) may predict MR response after CRT.
Methods: In 132 patients undergoing CRT, we measured peripheral venous levels of NT-proBNP, hsTnI, gal-3, and sST2 during device implantation. Patients were followed for two years. We measured Echo LV volumes, ejection fraction (EF), and MR grade at baseline and 6 months. MR was graded as no-trace (1), mild (2), moderate (3) or severe (4). MR improvement was defined as improvement of ≥1 grade by 6 months.
Results: Baseline MR was no-trace in 27 (21%) patients, mild in 43 (33%) and moderate/severe in 62 (47%). Median NT-proBNP and sST2 levels were higher in patients with significant (grade 3 or 4) MR vs grade 1 or 2 MR (2671 vs 991 pg/mL, p<0.001; 50 vs 40 ng/mL, p=0.03), while baseline hsTnI and gal-3 were not different. In patients with ≥mild MR at baseline, 50 (56%) had MR improvement at 6 months, with lower two-year mortality compared with those without MR improvement (0% vs 18%, p=0.002). With similar baseline LV volumes and EF, patients with MR improvement had lower baseline hsTnI and gal-3 levels (19 vs 40 pg/L, p=0.03; 14 vs 18 ng/mL, p=0.02) than those without; no difference was seen with NT-proBNP or sST2. In separate multivariable stepwise analyses, both log-transformed hsTnI (odd ratio [OR] 0.65, 95% CI 0.44 - 0.95, p=0.05) and log-transformed gal-3 (OR 0.13, 95% CI 0.03-0.58, p=0.006) remained independent predictors for MR improvement at 6 months.
Conclusion: Novel biomarkers of myonecrosis and fibrosis (hsTnI and gal-3) are associated with MR response after CRT, while markers of myocardial stretch and stress (NT-proBNP and sST2) are not. CRT patients whose MR did not improve by 6 months had worse 2-year survival. Predicting MR response with CRT can potentially influence clinical management; larger studies are therefore needed to confirm our findings.
Author Disclosures: J. Beaudoin: None. J.P. Singh: Research Grant; Significant; St. Jude Medical, Medtronic Inc, Boston Scientific Corp, Sorin Group, Biotronik, BG Medicine, Siemens. J. Szymonifka: None. Q. Zhou: None. R.A. Levine: None. J.K. Min: Research Grant; Significant; GE Healthcare, Vital Images, Phillips Healthcare. Consultant/Advisory Board; Significant; GE Healthcare, Arineta, Astra Zeneca, Bristol-Myers Squibb, Speakers’ Bureau of GE Healthcare. J.L. Januzzi: Research Grant; Significant; Roche Diagnostics, Siemens, BG Mediciner, Critical Diagnostics, Singulex, Thermo Fisher. Other Research Support; Significant; Roman W. Desanctis Distinguished Clinical Scholar Endowment. Q.A. Truong: Research Grant; Significant; St. Jude Medical, American College of Radiology Imaging Network, Duke Clinical Research Institute.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.