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ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 121-127

Evaluation of N-terminal pro B-type natriuretic peptide and echocardiographic parameters in congestive heart failure patients with pre- and post-cardiac resynchronization therapy


1 Department of Cardiac Services, Dharamshila Narayan Hridayala Hospital, Delhi, India
2 Department of Cardiology, Rajiv Gandhi Super Specialty Hospital, Delhi, India
3 Department of Anesthesiology, Rajiv Gandhi Super Specialty Hospital, Delhi, India
4 Department of Critical Care, Rajiv Gandhi Super Specialty Hospital, Delhi, India

Correspondence Address:
Dr. Praveen Singh
Rajiv Gandhi Super Specialty Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JICC.JICC_49_20

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Introduction: Cardiac resynchronization therapy (CRT) has rapidly evolved as a standard therapy for heart failure (HF) patients. Higher levels of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are typically used in the diagnosis of HF. Materials and Methods: A prospective, observational study of 60 patients with CRT was evaluated with clinical, laboratory and echocardiographic parameters. All patients underwent clinical examination, 6-min walk test, 12-lead electrocardiogram, two-dimensional echocardiographic with Doppler evaluations and NT-proBNP determination. Results: After effective CRT in patients, there was significant improvements in New York Heart Association functional class and 6-min walked distance along with significant decrease in mean QRS width and NT-proBNP plasma levels at 3 and 6 months' follow-up (P < 0.05). The repeat echocardiogram at 3 and 6 months' follow-up showed a significant reduction in the left ventricular end-systolic volume, left ventricular end diastolic volume, and significant left ventricular ejection fraction (LVEF) improvement (P < 0.05). No significant reduction in left ventricle (LV) diameters over 3 and 6 months' follow-up with a significant reduction in the MR severity after 6 months were observed (P < 0.05). At 6 months' follow-up, 75% patients (n = 45) were responders showing concordance between clinical, echocardiographic and NT-proBNP definitions of CRT response while 25% patients (n = 15) were nonresponders. The change in NT-proBNP levels between pre-CRT and 6 months' post CRT was significantly more important in responders than in nonresponders (P < 0.001). Conclusion: The present study shows the clinical benefit of treating patients with CRT and points to the reverse ventricular remodeling, with sustained decrease in LV volumes, plasma NT-proBNP, increase in LVEF, and decrease of the severity of mitral valve regurgitation.


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