Brain natriuretic peptide as a predictor of heart failure in patients with permanent pacemaker

Jelić, Vera; Milašinović, Goran; Pavlović, Siniša U.; Kanjuh, Vladimir; Živković, Mirjana

doi:10.2298/SARH0702021J

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Srpski arhiv za celokupno lekarstvo

2007, vol. 135, iss. 1-2, pp. 21-25

Brain natriuretic peptide as a predictor of heart failure in patients with permanent pacemaker

Jelić Vera^a, Milašinović Goran^a, Pavlović Siniša U.^a

, Kanjuh Vladimir^b, Živković Mirjana^a

^aClinical Center of Serbia, Pacemaker Cente, Belgrade, Serbia
^bSerbian Academy of Sciences and Arts - SASA, Belgrade, Serbia

email: vjelic@yubc.net

Keywords: brain natriuretic peptide; heart failure; pacemaker therapy

Abstract

Introduction: Brain natriuretic peptide (BNP) has a role in control of cardiovascular and renal functions. Objective The objective was to assess the predictive value of BNP levels for development of heart failure in patients with permanent pacemakers. Method In patients with implanted DDD pacemakers, BNP levels were measured at rest and after exercise testing, on DDD and VVI modes. There were 42 patients (25 males; 59.5%), without symptoms or signs of coronary disease or heart failure, and with normal echocardiograms. According to BNP levels, the patients were divided into three groups: with BNP levels lower than 80 pg/ml, BNP ranging from 81-150 pg/ml, and BNP levels over 151 pg/ml. Results In the first group (27 patients), BNP levels were significantly higher on VVI compared to DDD mode, both at rest and after exercise (p<0.01), with all BNP levels within normal range. In the second group (5 pts), BNP levels at rest were also significantly higher on VVI than on DDD mode, p<0.05. After exercise, these values were also higher on VVI compared to DDD mode, but without statistical significance. The third group (10 pts) as a whole had higher BNP values on VVI compared to DDD mode, with no statistical significance. In patients from this group who later developed heart failure, BNP levels were found to be significantly lower on DDD as opposed to VVI mode at rest, p<0.05, and even higher significance was found after exercise, p<0.01. After 6-year follow-up, 2 out of 5 patients from the second group developed dilated cardiomyopathy, and 8/10 patients in the third group experienced heart failure with LV EF 34.1±10%, LV EDD 6.1±0.42 cm, LV ESD 4.8±0.45 cm. Five of these patients died within the follow-up period. Conclusion The increased BNP levels can be valuable for early screening of patients with higher risk of heart failure. In patients with increased BNP at the time of pacemaker implantation, DDD pacing is a modality of choice.

Sažetak

Uvod: Moždani natriuretski peptid (brain natriuretic peptide - BNP) učestvuje u kontroli kardiovaskularnih i renalnih funkcija. Cilj rada Cilj rada je bio da se proceni prediktivna vrednost BNP na razvoj insuficijencije srca kod bolesnika sa stalnim pejsmejkerom. Metod rada Kod bolesnika kojima je ugrađen dvokomorski (DDD) pejsmejker određivan je nivo BNP u stanju mirovanja i posle testa opterećenja na DDD i jednokomorskom (VVI) modu. Ispitana su 42 bolesnika (25 muškaraca, 59,5%) bez simptoma ili znakova koronarne bolesti ili insuficijencije rada srca i sa normalnim ehokardiogramom. Ispitanici su svrstani u tri grupe prema nivo u BNP: do 80 pg/ml - prva grupa (27 bolesnika), od 81 do 150 pg/ml - druga grupa (pet bolesnika), a više od 151 pg/ml - treća grupa (10 bolesnika). Nivo značajnosti razlika između grupa izračunat je Studentovim t-testom. Rezultati U prvo j grupi vrednosti BNP su bile statistički značajno veće na VVI nego na DDD modu u stanju mirovanja i pri opterećenju (p<0,001), pri vrednostima BNP u normalnom opsegu. U drugoj grupi vrednosti BNP u mirovanju su na VVI modu bile statistički značajno veće (p<0,005). Pri opterećenju ov e vrednosti su takođe bile više na VVI nego na DDD modu, ali bez statističke značajnosti. Treća grupa je imala vrednosti BNP veće na VVI nego na DDD modu, ali bez statističke značajnosti. Kod bolesnika ov e grupe kod kojih se razvila insuficijencija srca tokom ispitivanja utvrđena je značajna razlika u vrednosti BNP na DDD u odnosu na VVI modu mirovanju (p<0,05), dok je pri opterećenju značajnost bila još veća (p<0,01). Posle šest godina nadgledanja kod dva bolesnika druge grupe razvila se dilataciona kardiomiopatija, a kod osam ispitanika treće grupe insuficijencija srca, s prosečnom ejekcionom frakcijom od 34,12±10%. End-dijastolni prečnik lev e komore (LVEDD) kod bolesnika s malom ejekcionom frakcijom bio je 6,1±0,42 cm, a end-sistolni prečnik lev e komore (LVESD) 4,8±0,45 cm. Tokom perioda nadgledanja pet bolesnika iz treće grupe je umrlo. Zaključak Određivanje nivoa BNP može biti korisno u ranom otkrivanju bolesnika s povećanim rizikom za nastanak insuficijencije rada srca. DDD pejsing je modalitet izbora kod bolesnika s povišenim vrednostima BNP u vreme implantacije.

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article language: Serbian
document type: Paper
DOI: 10.2298/SARH0702021J
published in SCIndeks: 23/01/2008

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