Quynh A Truong1, James L Januzzi2, Jackie Szymonifka3, Wai-ee Thai2, Bryan Wai2, Zachary Lavender2, Umesh Sharma2, Ryan M Sandoval2, Zachary S Grunau2, Sandeep Basnet2, Adefolakemi Babatunde2, Olujimi A Ajijola4, James K Min5, Jagmeet P Singh6. 1. Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York; Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: qat9001@med.cornell.edu. 2. Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 3. Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts. 4. University of California Cardiac Arrhythmia Center, Ronald Reagan Medical Center, Los Angeles, California. 5. Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York. 6. Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: A significant minority of patients receiving cardiac resynchronization therapy (CRT) remain nonresponsive to this intervention. OBJECTIVE: This study aimed to determine whether coronary sinus (CS) or baseline peripheral venous (PV) levels of established and emerging heart failure (HF) biomarkers are predictive of CRT outcomes. METHODS: In 73 patients (aged 68 ± 12 years; 83% men; ejection fraction 27% ± 7%) with CS and PV blood samples drawn simultaneously at the time of CRT device implantation, we measured amino-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble ST2 (sST2) levels. NT-proBNP concentrations >2000 pg/mL, gal-3 concentrations >25.9 ng/mL, and sST2 concentrations >35 ng/mL were considered positive on the basis of established PV cut points for identifying "high-risk" individuals with HF. CRT response was adjudicated by the HF Clinical Composite Score. A major adverse cardiovascular event (MACE) was defined as the composite end point of death, cardiac transplant, left ventricular assist device, and HF hospitalization at 2 years. RESULTS: NT-proBNP concentrations were 20% higher in the CS than in the periphery, while gal-3 and sST2 concentrations were 10% higher in the periphery than in the CS (all P < .001). There were 45% CRT nonresponders at 6 months and 16 (22%) patients with MACE. Triple-positive CS values yielded the highest specificity of 95% for predicting CRT nonresponse. Consistently, CS strategies identified patients at higher risk of developing MACE, with >11-fold adjusted increase for triple-positive CS patients compared to triple-negative patients (all P ≤ .04). PV strategies were not predictive of MACE. CONCLUSION: Our findings suggest that CS sampling of HF biomarkers may be better than PV sampling for predicting CRT outcomes. Larger studies are needed to confirm our findings.
BACKGROUND: A significant minority of patients receiving cardiac resynchronization therapy (CRT) remain nonresponsive to this intervention. OBJECTIVE: This study aimed to determine whether coronary sinus (CS) or baseline peripheral venous (PV) levels of established and emerging heart failure (HF) biomarkers are predictive of CRT outcomes. METHODS: In 73 patients (aged 68 ± 12 years; 83% men; ejection fraction 27% ± 7%) with CS and PV blood samples drawn simultaneously at the time of CRT device implantation, we measured amino-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble ST2 (sST2) levels. NT-proBNP concentrations >2000 pg/mL, gal-3 concentrations >25.9 ng/mL, and sST2 concentrations >35 ng/mL were considered positive on the basis of established PV cut points for identifying "high-risk" individuals with HF. CRT response was adjudicated by the HF Clinical Composite Score. A major adverse cardiovascular event (MACE) was defined as the composite end point of death, cardiac transplant, left ventricular assist device, and HF hospitalization at 2 years. RESULTS: NT-proBNP concentrations were 20% higher in the CS than in the periphery, while gal-3 and sST2 concentrations were 10% higher in the periphery than in the CS (all P < .001). There were 45% CRT nonresponders at 6 months and 16 (22%) patients with MACE. Triple-positive CS values yielded the highest specificity of 95% for predicting CRT nonresponse. Consistently, CS strategies identified patients at higher risk of developing MACE, with >11-fold adjusted increase for triple-positive CS patients compared to triple-negative patients (all P ≤ .04). PV strategies were not predictive of MACE. CONCLUSION: Our findings suggest that CS sampling of HF biomarkers may be better than PV sampling for predicting CRT outcomes. Larger studies are needed to confirm our findings.
Authors: James L Januzzi; Shafiq U Rehman; Asim A Mohammed; Anju Bhardwaj; Linda Barajas; Justine Barajas; Han-Na Kim; Aaron L Baggish; Rory B Weiner; Annabel Chen-Tournoux; Jane E Marshall; Stephanie A Moore; William D Carlson; Gregory D Lewis; Jordan Shin; Dorothy Sullivan; Kimberly Parks; Thomas J Wang; Shawn A Gregory; Shanmugam Uthamalingam; Marc J Semigran Journal: J Am Coll Cardiol Date: 2011-10-25 Impact factor: 24.094
Authors: Ravi V Shah; Annabel A Chen-Tournoux; Michael H Picard; Roland R J van Kimmenade; James L Januzzi Journal: Eur J Heart Fail Date: 2010-06-05 Impact factor: 15.534
Authors: Bonnie Ky; Benjamin French; Kristin McCloskey; J Eduardo Rame; Erin McIntosh; Puja Shahi; Daniel L Dries; W H Wilson Tang; Alan H B Wu; James C Fang; Rebecca Boxer; Nancy K Sweitzer; Wayne C Levy; Lee R Goldberg; Mariell Jessup; Thomas P Cappola Journal: Circ Heart Fail Date: 2010-12-22 Impact factor: 8.790
Authors: Domingo A Pascual-Figal; Sergio Manzano-Fernández; Miguel Boronat; Teresa Casas; Iris P Garrido; Juan C Bonaque; Francisco Pastor-Perez; Mariano Valdés; James L Januzzi Journal: Eur J Heart Fail Date: 2011-05-06 Impact factor: 15.534
Authors: Domingo A Pascual-Figal; Jordi Ordoñez-Llanos; Pedro L Tornel; Rafael Vázquez; Teresa Puig; Mariano Valdés; Juan Cinca; Antoni Bayes de Luna; Antoni Bayes-Genis Journal: J Am Coll Cardiol Date: 2009-12-01 Impact factor: 24.094
Authors: Rudolf A de Boer; Dirk J A Lok; Tiny Jaarsma; Peter van der Meer; Adriaan A Voors; Hans L Hillege; Dirk J van Veldhuisen Journal: Ann Med Date: 2010-12-28 Impact factor: 4.709
Authors: Neal A Chatterjee; Jagmeet P Singh; Jackie Szymonifka; Roderick C Deaño; Wai-Ee Thai; Bryan Wai; James K Min; James L Januzzi; Quynh A Truong Journal: Int J Cardiol Date: 2015-12-11 Impact factor: 4.164
Authors: Jonathan Beaudoin; Jagmeet P Singh; Jackie Szymonifka; Qing Zhou; Robert A Levine; James L Januzzi; Quynh A Truong Journal: Can J Cardiol Date: 2016-06-02 Impact factor: 5.223
Authors: Mattia Arrigo; Nicolas Vodovar; Hélène Nougué; Malha Sadoune; Chris J Pemberton; Pamela Ballan; Pierre-Olivier Ludes; Nicolas Gendron; Alain Carpentier; Bernard Cholley; Philippe Bizouarn; Alain Cohen-Solal; Jagmeet P Singh; Jackie Szymonifka; Christian Latremouille; Jane-Lise Samuel; Jean-Marie Launay; Julien Pottecher; A Mark Richards; Quynh A Truong; David M Smadja; Alexandre Mebazaa Journal: Eur Heart J Date: 2018-05-21 Impact factor: 29.983
Authors: Quynh A Truong; Jackie Szymonifka; James L Januzzi; Jigar H Contractor; Roderick C Deaño; Neal A Chatterjee; Jagmeet P Singh Journal: Heart Rhythm Date: 2018-12-24 Impact factor: 6.343
Authors: Jonathan Beaudoin; Jackie Szymonifka; Zachary Lavender; Roderick C Deaño; Qing Zhou; James L Januzzi; Jagmeet P Singh; Quynh A Truong Journal: J Thorac Dis Date: 2019-12 Impact factor: 2.895
Authors: Christopher J McAloon; Danish Ali; Thomas Hamborg; Prithwish Banerjee; Paul O'Hare; Harpal Randeva; Faizel Osman Journal: Open Heart Date: 2017-08-21