Clinical correlates of B-type natriuretic peptide monitoring in outpatients with left ventricular assist device

Hegarová, Markéta; Kubánek, Miloš; Netuka, Ivan; Malý, Jiří; Dorazilová, Zora; Gazdic, T.; Franeková, Janka; Lánská, Věra; Melenovský, Vojtěch; Kautzner, Josef; Málek, I

doi:10.5507/bp.2017.003

Cited by 7 publications

(12 citation statements)

References 27 publications

(35 reference statements)

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“…Therefore, the prognostic value of NP levels before LVAD implantation may be changed by the therapy itself. Nonetheless, several studies have shown that NP measurements and their fluctuations during LVAD therapy are strongly related to adverse outcome including mortality ( 28 , 29 , 45 ). These findings may suggest, that NP levels before implantation and during LVAD support may not have similar predictive value for all-cause mortality, as the hemodynamic support provided by the LVAD may change NP levels and the accompanied mortality risk.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, BNP levels before LVAD implantation were associated with MAEs between 2 weeks up to 2 years (42,43,45). In a sub-analysis, Hegarova et al demonstrated that although BNP was associated with adverse events up to 1.5 years after initial discharge, it was not associated with subsequent rehospitalizations (45). The two studies analyzing NT-proBNP levels found that it was not associated with complicated post-operative stay.…”

Section: Major Adverse Eventsmentioning

confidence: 97%

“…NT-proBNP measured at "hospital admission" before LVAD implantation was an independent predictor for rehospitalization due to cardiac, bleeding, infection, thrombosis, pump related, biliary, or "elective" events (44). Of the studies reporting on associative relations, three studies analyzed BNP levels and two studies analyzed NT-proBNP levels (42,(44)(45)(46). In these studies, BNP levels before LVAD implantation were associated with MAEs between 2 weeks up to 2 years (42,43,45).…”

Section: Major Adverse Eventsmentioning

confidence: 99%

“…Of the studies reporting on associative relations, three studies analyzed BNP levels and two studies analyzed NT-proBNP levels (42,(44)(45)(46). In these studies, BNP levels before LVAD implantation were associated with MAEs between 2 weeks up to 2 years (42,43,45). In a sub-analysis, Hegarova et al demonstrated that although BNP was associated with adverse events up to 1.5 years after initial discharge, it was not associated with subsequent rehospitalizations (45).…”

Section: Major Adverse Eventsmentioning

confidence: 99%

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Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review

Janssen

Jukema

Beeres

et al. 2021

Front. Cardiovasc. Med.

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Aims: Major adverse event (MAE) rates during left ventricular assist device (LVAD) therapy in advanced heart failure (HF) patients are high, and impair quality of life and survival. Prediction and risk stratification of MAEs in order to improve patient selection and thereby outcome during LVAD therapy is therefore warranted. Circulating natriuretic peptides (NPs) are strong predictors of MAEs and mortality in chronic HF patients. However, whether NPs can identify patients who are at risk of MAEs and mortality or tend toward myocardial recovery after LVAD implantation is unclear. The aim of this systematic review is to analyze the prognostic value of circulating NP levels before LVAD implantation for all-cause mortality, MAEs and myocardial recovery after LVAD implantation.Methods and Results: Electronic databases were searched for studies analyzing circulating NP in adults with advanced HF before LVAD implantation in relation to mortality, MAEs, or myocardial recovery after LVAD implantation. Twenty-four studies published between 2008 and 2021 were included. Follow-up duration ranged from 48 hours to 5 years. Study sample size ranged from 14 to 15,138 patients. Natriuretic peptide levels were not predictive of all-cause mortality. However, NPs were predictive of right ventricular failure (RVF) and MAEs such as ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization. No relation between NPs and myocardial recovery was found.Conclusion: This systematic review found that NP levels before LVAD implantation are not predictive of all-cause mortality after LVAD implantation. Thus, NP levels may be of limited value in patient selection for LVAD therapy. However, NPs help in risk stratification of MAEs and may be used to identify patients who are at risk for RVF, ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization after LVAD implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Major Adverse Eventsmentioning

confidence: 97%

Section: Major Adverse Eventsmentioning

confidence: 99%

Section: Major Adverse Eventsmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review

Janssen

Jukema

Beeres

et al. 2021

Front. Cardiovasc. Med.

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“…LVAD parameters such as flow rates may also be an indication of infectious complications [61]. Elevations of B-type natriuretic peptide (BNP) were also found to be a marker of serious adverse events in LVAD patients, including severe infections such as sepsis, mediastinitis and pump pocket infections [72]. Thrombosis, alteration in coagulation parameters, stroke, acute renal failure may also be early indicators of infection as well as more routine signs such as fever, leukocytosis and localizing signs and symptoms.…”

Section: Diagnosis Of Lvad Infectionsmentioning

confidence: 99%

Left Ventricular Assist Device Infections

Skalweit¹

2018

Advanced Concepts in Endocarditis

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Left ventricular assist device (LVAD) infections are important causes of morbidity and mortality in patients who receive these mechanical circulatory supports as a bridge to transplantation (BTT) or as destination therapy (DT) (for individuals who are not candidates for cardiac transplant). Infections are more common among persons who received pulsatile flow LVADs as opposed to newer continuous flow (CF) devices. Other risk factors for infection include obesity, renal failure, depression and immunosuppression. An LVAD infection increases the risk of infections in persons who undergo cardiac transplantation. Infections include percutaneous site, driveline, pump pocket and pump/cannula infections; sepsis, bacteremia, mediastinitis and endocarditis. Diagnosis is achieved by monitoring LVAD flow parameters and observing typical clinical and laboratory manifestations of infection. Imaging such as PET-CT or SPECT-CT imaging can be helpful to establish a diagnosis of pump pocket infection. Echocardiography may aid in detecting native valve endocarditis and thrombus associated with the LVAD. The most common pathogens include Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Candida spp. Treatment requires targeted antimicrobials plus surgical debridement of infected tissue and device components. In cases of pump/cannula/LVAD endocarditis, especially if fungal pathogens or Mycobacterium chimaera are involved, LVAD removal/reimplantation vs. transplant is necessary, combined with extended antimicrobial therapy.

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The contribution of cardiac and extracardiac factors to NT-proBNP concentrations in patients with advanced heart failure before and after left ventricular assist device implantation

et al. 2021

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Clinical correlates of B-type natriuretic peptide monitoring in outpatients with left ventricular assist device

Abstract: Serial measurement of BNP in outpatients with LVAD correlates with the occurrence of adverse events. Assessment of absolute values of BNP peak seems to have a similar accuracy to analysis of intra-individual variation of BNP and it is more practical.

Cited by 7 publications

References 27 publications

Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review

Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review

Left Ventricular Assist Device Infections

The contribution of cardiac and extracardiac factors to NT-proBNP concentrations in patients with advanced heart failure before and after left ventricular assist device implantation

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