ABSTRACT
La terapia de resincronización cardiaca es una herramienta novedosa y efectiva para el tratamiento de los pacientes con falla cardiaca que no han respondido a medidas farmacológicas óptimas y que además tienen deterioro en su clase funcional y disincronía ventricular. Se ha demostrado que el péptido natriurético cerebral (BNP) determina de manera cuantitativa la severidad de la falla cardiaca y que su concentración sanguínea guarda correlación directamente proporcional con el grado de falla cardiaca.En este trabajo se hace una evaluación prospectiva de los niveles de BNP, función ventricular, clase funcional, evolución clínica, duración del QRS, caminata de seis minutos, hospitalización no programada y mortalidad en los pacientes, antes y a 3, 6 y 9 meses de seguimiento, luego del implante de la terapia de resincronización cardiaca.
Cardiac resynchronization therapy (CRT) is a novel and effective tool for the treatment of patients with severe heart failure (HF), left ventricular systolic dysfunction and desynchrony, that have not responded to the optimal pharmacological therapy. It has been demonstrated that brain natriuretic peptide (BNP) quantitative determines severity of the HF and their blood levels keep direct proportional correlation to the severity of HF. We prospectively evaluated levels of brain natriuretic peptide (BNP), left ventricular function, New York Heart Association (NYHA) class, QRS duration, and 6-minute hall walk test in a group of patients before biventricular device implantation at 3-6 and 12 months of follow-up. Clinical evolution, not programmed hospitalization and mortality were also evaluated. A total of 34 patients were enrolled and followed for a mean of nine months. A decrease in BNP levels (645 pg/ml, 320 pg/ml and 147 pg/ml pre-implant, 6 months and 9 months respectively. p < 0.0001) was demonstrated; improvement in ventricular function (LVEF 23% vs. 31% p < 0.002), NYHA class (3.53 vs. 1.97 p < 0.0001), QRS duration (142 msec. vs. 116 msec. p < 0.0001) and 6-minute hall walk test (150 meters vs. 328 meters p < 0.0001). Hospitalization rate was 38% and mortality rate was 8.8%. Conclusions: levels of BNP in patients with CRT decrease significantly and keep relationship with the clinical, electrocardiographic and echocardiographic evolution of HF, being useful as prognostic marker and follow-up tool in these patients.