Heart Failure -> Cardiac Resynchronization Therapy: -> Surgical & Other D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-071 - Combination Of Brain Natriuretic Peptide And Heart Rate Variability In Predicting Long-Term Outcomes In Cardiac Resynchronization Therapy Patients (ID 420)


Background: The long-term prognostic significance of the combination of brain natriuretic peptide (BNP) and heart rate variability (HRV) among patients receiving cardiac resynchronization therapy with defibrillator (CRT-D) is not well understood.
Objective: To assess whether measuring a combination of BNP and HRV at baseline carries prognostic significance during long-term follow-up among CRT-D recipients
Methods: Our cohort consisted of 441 CRT-D patients from MADIT-CRT. The uppermost tertile (T3) of baseline BNP levels signified high BNP; the two lower tertiles (T1 and T2) represented low BNP. The standard deviation of all normal-to-normal RR intervals (SDNN), a time-domain HRV parameter, was assessed at baseline. The lowest tertile (T1) of SDNN characterized low HRV; the two upper tertiles (T2 and T3) represented preserved HRV. The effects of BNP and HRV were evaluated using four sub-groups: (1) high BNP, low HRV; (2) high BNP, preserved HRV; (3) low BNP, low HRV; and (4) low BNP, preserved HRV. Primary endpoint was heart failure or death (HF/death) and death alone during median follow-up of 5.6 years.
Results: Among CRT-D recipients, patients with high BNP (>120 pg/mL) and low HRV (≤93 ms) had greatest risk of long-term HF/death (HR=3.49, p<0.001) and death (HR=2.61, p=0.041), relative to patients with low BNP (≤120 pg/mL) and preserved HRV (>93 ms) [Figure]. When compared to ICD recipients, only the CRT-D patients with low BNP and preserved HRV experienced reduction in HF/death (HR=0.59, p=0.008) and death (HR=0.46, p=0.019).
Conclusion: In CRT-D patients, the presence of both elevated BNP and low HRV at baseline is associated with adverse long-term outcomes.