Abstract
Background
Cardiac resynchronization therapy (CRT) improves mitral regurgitation (MR) in a subset
of patients. We hypothesized that biomarkers (amino-terminal pro-B type natriuretic
peptide, high-sensitivity troponin I, galectin-3 [gal-3], and soluble ST2) might predict
MR response after CRT.
Methods
We measured levels of biomarkers during CRT implantation in 132 patients with a subsequent
2-year follow-up. MR was graded as no-trace, mild, moderate, or severe at baseline
and at 6 months.
Results
In patients with baseline at least mild MR, 56% had improvement at 6 months, with
lower 2-year mortality vs patients without improvement (0% vs 18%; P = 0.002). At baseline, patients with MR improvement had lower high-sensitivity troponin
I and gal-3 levels compared with those without improvement (19 vs 40 pg/L; P = 0.01; 14 vs 18 ng/mL; P = 0.007). In multivariable analyses, higher log-transformed gal-3 (odds ratio, 0.15;
95% confidence interval, 0.04-0.65; P = 0.01) remained an independent predictor for MR nonimprovement. Levels of pro-B
type natriuretic peptide and soluble ST2 were lower at follow-up in patients with
MR improvement (potentially reflecting reduced myocardial stretch and stress) without
reaching statistical significance.
Conclusions
Higher galectin levels at the time of CRT implantation are associated with MR nonresponse.
Résumé
Introduction
Le traitement de resynchronisation cardiaque (TRC) améliore la régurgitation mitrale
(RM) chez certains patients. Nous avons posé l’hypothèse que les biomarqueurs (amino-terminal
du propeptide natriurétique de type B, troponine I de haute sensibilité, galectine-3
[gal-3] et ST2 soluble) prédiraient l'évolution de la RM après le TRC.
Méthodes
Nous avons mesuré les concentrations des biomarqueurs lors de l’implantation d’un
dispositif de TRC chez 132 patients avec suivi subséquent de 2 ans. La RM était classifiée
comme suit : aucune, trace, légère, modérée ou sévère, initialement et après 6 mois.
Résultats
Chez les patients qui avaient initialement une RM au moins légère, 56 % montraient
une amélioration à 6 mois, avec une mortalité plus basse à 2 ans par rapport aux patients
sans amélioration (0 % vs 18 %; P = 0,002). Les patients avec amélioration de la RM avaient des concentrations initialement
plus faibles de troponine I de haute sensibilité et de gal-3 que ceux sans amélioration
(19 vs 40 pg/l; P = 0,01; 14 vs 18 ng/ml; P = 0,007). Dans les analyses multivariables, une gal-3 log-transformée plus élevée
(ratio d’incidences, 0,15; intervalle de confiance à 95 %, 0,04-0,65; P = 0,01) demeurait un prédicteur indépendant de la non-amélioration de la RM. Les
concentrations du propeptide natriurétique de type B et de la ST2 soluble étaient
plus faibles lors du suivi chez les patients qui montraient une amélioration de la
RM (reflétant potentiellement la réduction de l’étirement et du stress myocardiques)
sans atteindre la signification statistique.
Conclusions
Des concentrations plus élevées de galectine lors de l’implantation de TRC sont associées
à la non-réponse de la RM.
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Article info
Publication history
Published online: June 02, 2016
Accepted:
May 25,
2016
Received:
March 5,
2016
Footnotes
See page 1483 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
