doiSerbia

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

Jelić Vera (Pejsmejker centar, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Milašinović Goran (Pejsmejker centar, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Pavlović Siniša U. (Pejsmejker centar, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Kanjuh Vladimir (Srpska akademija nauka i umetnosti, Beograd)
Živković Mirjana (Pejsmejker centar, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)

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.

Keywords: brain natriuretic peptide, heart failure, pacemaker therapy