Dynamics and prognostic value of B-type natriuretic peptide in left ventricular assist device recipients

Abstract

Background: The prognostic utility of B-type natriuretic peptide (BNP) in heart failure is well recognized. Previous studies demonstrated that BNP levels decrease after left ventricular assist device (LVAD) implantation. We sought to investigate the predictive value of baseline and changes in BNP levels in LVAD recipients. Methods: BNP was measured in baseline and follow-up plasma samples from consecutive patients receiving a continuous-flow LVAD from 2010 through 2016. Absolute values and changes from baseline were related to clinical outcomes. Results: Median BNP at baseline was 885 [interquartile range (IQR): 450-1,624] pg/mL, decreasing to 289 (IQR: 154-534) pg/mL at 90 days after LVAD implantation. Cox regression analysis revealed that higher baseline and follow-up BNP levels were not associated with increased risk of death at 180 days (P=0.12 and P=0.32, respectively). In the univariate analysis 90-day BNP, but not baseline BNP, was significantly associated with the combined death/hospitalization outcome 180 days after LVAD implantation [hazard ratio (HR) 1.03, 95% CI: 1.01-1.06; P=0.006]. This significance was not preserved after adjusting for multiple covariates (HR 1.01, 95% CI: 0.98-1.04; P=0.62). At 90 days, there was no BNP lowering in 20.6% of subjects. This was not associated with higher risk for death or the composite of death/hospitalization (P=0.11 and P=0.06 respectively). Conclusions: BNP absolute levels and changes from baseline are not independently associated with clinical outcomes after LVAD-implantation. These findings suggest an impaired prognostic performance of BNP after LVAD implantation.

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

“…Five studies analyzed the predictive value of NPs for all-cause mortality, of which 4 studies included BNP and 1 study included NT-proBNP ( Table 2 ). None of the studies found BNP levels before LVAD implantation predictive of all-cause mortality ( 28 – 31 ). In contrast, NT-proBNP levels before LVAD implantation were predictive of 30-days all-cause mortality ( 32 ).…”

“…In contrast, Topilsky et al demonstrated that preoperative NT-proBNP levels are predictive of 1-month mortality after LVAD implantation ( 32 ). The study by Papathanasiou et al analyzing BNP, had a similar study sample size and baseline characteristics compared to the study by Topilsky et al, but did not report a significant predictive relation ( 28 ). The differences in type of NPs and length of follow-up may have contributed to this contradictory finding.…”

“…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.…”

Prognostic Implications of Ambulatory N-Terminal Pro-B-Type Natriuretic Peptide Changes in Patients with Continuous-Flow Left Ventricular Assist Devices

“…They found no association between preimplant BNP concentrations, outpatient BNP at 3 months, and intra-individual change in BNP with all-cause mortality or hospitalization from any cause at 180 days. 24 One crucial difference from previous studies is that we have only utilized post-implant NT-pro BNP values obtained in ambulatory setting to characterize prognosis.…”

Galectin-3 and sST2 as Prognosticators for Heart Failure Requiring Extracorporeal Life Support: Jack n’ Jill

“…The early decrease in BNP level is indicative of ventricular unloading during ECLS but the rebound in BNP level after decannulation suggests BNP is not an ideal biomarker to predict complete normalization of cardiac function [ 5 ]. Other heart failure related biomarkers which have been explored in patients who underwent ECLS include dynamic BNP [ 8 ], galectin-3 [ 9 ], ST2 [ 10 ], matrix metalloproteinase-9 (MMP-9) [ 11 ], tissue inhibitors of metalloproteinase-1 (TIMP-1) [ 11 ], MMP-2 [ 11 , 12 ], osteopontin [ 13 ], MR-proANP [ 14 ], proADM [ 14 ], and copeptin [ 14 ]. The above-depicted biomarkers may assist to predict outcomes of heart failure requiring ECLS under limited circumstances and their identifications are summarized in Table 1 .…”