Effect Of Cardiac Resynchronization Therapy On Cardiac Neurohormone In Heart Failure

Objective: To analyze the serum Norepinephrine(NE),Brain natriuretic peptide(BNP),Procollagen-III-N-Terminal-Propeptide(PIIINP)and Nerve grow facter(NGF)concentration changes preoperative and postoperative cardiac resynchronization therapy(CRT/CRT-D),explore the effect of CRT on the cardiac neurohormone;and to analyze the clinical efficacy of CRT.Methods: A total of 24 patients who underwent heart failure with CRT were entrolled from Apr 2014 to Oct 2015 in the Arrhythmia Section of the First Affiliated Hospital of Dalian Medical University,24 heart failure patients to match CRT group and 24 healthy individuals at the same period.All enrolled subjects underwent routine tests to exclude infections,severe liver and kidney disease,stroke,cancer,autoimmune diseases,hyperthyroidism,blood diseases.Preoperative and postoperative CRT 3?6 months,respectively evaluated the clinical symptoms,performed NYHA class,12-lead electrocardiography measured QRS duration,echocardiography measured left ventricular ejection fraction(LVEF)?left ventricular end-diastolic diameter(LVEDD);serum NE,BNP,PIIINP and NGF detected with ELISA,and make statistical comparison.All heart failure patients respectively performed above data preoperative and postoperative CRT 3?6 months.The controls only performed data after study entry.We defined the respond standard as NYHA function class ? 1 grade,improvement of LVEF?10%.Data was analyzed with SPSS 22.0.When P <0.05,the difference was considered to be significant.Results: The 24 CRT patients[mean age64.18±9.81 years,15males(62.5%)],the 24 non-CRT patients[mean age65.55±11.44 years,16 males(66.7%)],the 24 healthy[mean age62.85±8.99 years,15males(62.5%)].Between CRT and non-CRT group,the baseline of NYHA?LVEF?LVEDD?QRS had no significant difference.After follow-up for 6 months,there were significant changes in NYHA class(2.16±0.59 vs 3.18±0.67,P<0.01)?LVEF(35.47±11.50% vs 28.12±10.93%,P<0.01)?LVEDD(60.50±8.72 mm vs 64.59±8.24 mm,P=0.04)?QRS duration(136.81±30.52 ms vs 167.31±31.43 ms,P<0.01)in CRT group,and the non-CRT group had nothing change.The baseline serum BNP?NE?PIIINP levels of all heart failure patients were higher than healthy control group(P<0.05).The baseline of four neurohormones had no significant difference between CRT and non-CRT group.After follow-up for 6 months,the serum NE(174.76±18.41 pg/ml vs 138.79±17.02 pg/ml,P<0.01)?BNP [148.0(538.5)pg/ml vs 434.2(1018.1)pg/ml,P<0.01] of CRT group were significantly lower,the serum PIIINP?NGF did not change significantly.The serum BNP of non-CRT group were higher than preoperative,the other neurohormone levels of non-CRT group were not change significantly.In our study,19 patients of CRT group were classified as responders after 6 months,rate of response was 79.2%.1 died because of the end heart failure,the incidence was 4.2%.The serum PIIINP of responders was lower than non-responders(1.41±0.97pg/ml vs 1.75±0.87pg/ml,P=0.03).Univariate and multivariate analysis showed that PIIINP is a potential marker to predict response to CRT,lower preoperative PIIINP prone CRT response(OR=0.17,95% CI=0.05-1.02,P=0.04).During follow up,3 patients(12.5%)suffered from re-hospitalization in CRT group,and no responders went back to hospital.In non-CRT group 11 patients(45.8%)went back to hospital for heart failure.Conclusions: CRT is an effective therapy for heart failure,and it can improve cardiac function,reverse left ventricular diameter,narrow QRS duration,improve left ventricular ejection fraction.After CRT implantation can reduce serum BNP?NE levels,the serum PIIINP of CRT responders was lower than non-responders.The lower preoperative PIIINP prone CRT response,PIIINP is a potential serum marker to predict response to CRT.