McAloon, Christopher, Barwari, Temo, Hu, Jimiao, Hamborg, Thomas, Nevill, Alan, Hyndman, Samantha, Ansell, Valerie, Musa, Anntoniette, Jones, Julie, Goodby, Julie, Banerjee, Prithwish, O’Hare, Paul, Mayr, Manuel, Randeva, Harpal S. and Osman, Faizel (2018) Characterisation of circulating biomarkers before and after cardiac resynchronisation therapy and their role in predicting CRT response: the COVERT-HF study. Open Heart, 5 (2). e000899. doi:10.1136/openhrt-2018-000899 ISSN 2053-3624.

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Abstract

Aims Cardiac resynchronisation therapy (CRT) is effective treatment for selected patients with heart failure (HF) but has ~30% non-response rate. We evaluated whether specific biomarkers can predict outcome.

Methods A prospective single-centre pilot study of consecutive unselected patients undergoing CRT for HF between November 2013 and December 2015 evaluating cardiac extracellular matrix biomarkers and micro-ribonucleic acid (miRNA) expression before and after CRT assessing ability to predict functional response and survival. Each underwent three assessments (pre-implant, 6  weeks and 6  months postimplant) including: New York Heart Association (NYHA) class, echocardiography, electrocardiography, 6  min walk test (6MWT), Minnesota Living with Heart Failure Questionnaire (MLHFQ) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Plasma markers of cardiac fibrosis assessed were: N-terminal pro-peptides of collagen I and III, collagen I C-terminal telopeptides (CTx) and matrix metalloproteinases (MMP-2 and MMP-9) as well as a panel of miRNAs (miRNA-21, miRNA-30d, miRNA-122, miRNA-133a, miRNA-210 and miRNA-486).

Results A total of 52 patients were recruited; mean age (±SD) was 72.4±9.4 years; male=43 (82.7%), ischaemic aetiology=30 (57.7%), mean QRS duration=166.4±23.5  ms, left bundle branch block (LBBB) morphology = 39 (75.0%), mean NYHA=2.7±0.6, 6MWT=238.8±130.6  m, MLHFQ=46.4±21.3  and left ventricular ejection fraction (LVEF)=24.3%±8.0%. Mean follow-up=1.7±0.3  and 5.8±0.7 months. There were 27 (55.1%) functional responders (3 no definable 6-month response; 2 missed assessments and 1 long-term lead displacement). No marker predicted response, however, CTx and LBBB trended most towards predicting functional response.

Conclusion No specific biomarkers reached significance for predicting functional response to CRT. CTx showed a trend towards predicting response and warrants further study.

Trial registration number NCT02541773.

Item Type:	Journal Article
Subjects:	Q Science > QP Physiology R Medicine > R Medicine (General) R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Heart failure -- Treatment, Cardiac pacing, Extracellular matrix, MicroRNA, Biochemical markers -- Diagnostic use
Journal or Publication Title:	Open Heart
Publisher:	B M J Group
ISSN:	2053-3624
Official Date:	18 October 2018
Dates:	Date Event 18 October 2018 Published 20 September 2018 Accepted
Volume:	5
Number:	2
Article Number:	e000899
DOI:	10.1136/openhrt-2018-000899
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	16 January 2020
Date of first compliant Open Access:	16 January 2020
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED University Hospitals Coventry and Warwickshire NHS Trust http://viaf.org/viaf/152707181

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