Early trends in N-terminal pro-brain natriuretic peptide values after left ventricular assist device implantation for chronic heart failure

Tal Hasin, Sudhir S. Kushwaha, Timothy G. Lesnick, Walter K Kremers, Barry A. Boilson, John A. Schirger, Alfredo L. Clavell, Richard J. Rodeheffer, Robert Frantz, Brooks Sayre Edwards, Naveen Luke Pereira, John M. Stulak, Lyle Joyce, Richard Daly, Soon J. Park, Allan S Jaffe

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Left ventricular assist devices (LVADs) acutely decrease left ventricular wall stress. Thus, early postoperative levels of N-terminal proebrain natriuretic peptide (NT-proBNP) should decrease. This study investigated postoperative changes in NT-proBNP levels, the parameters related to changes, and the possible association with complications by performing a retrospective analysis of changes in daily NT-proBNP (pg/ml) levels from admission to discharge both before and after LVAD implantation in a tertiary referral center. For 72 patients implanted with HeartMate II LVADs, baseline NT-proBNP levels were elevated at 3,943 ng/ml (interquartile range 1,956 to 12,964). Preoperative stabilization led to marked decreases in NT-proBNP. Levels peaked 3 days after surgery and subsequently decreased. Patients with complicated postoperative courses had higher early postoperative elevations. By discharge, NT-proBNP decreased markedly but was still 2.83 (1.60 to 5.76) times the age-based upper limit of normal. The 26% reduction in NT-proBNP between admission and discharge was due mostly to the preoperative reductions and not those induced by the LVAD itself. The decrease was not associated with decreases in LV volume. In conclusion, preoperative treatment reduces NT-proBNP values. The magnitude of early postoperative changes is related to the clinical course. Levels at discharge remain markedly elevated and similar to values after preoperative stabilization despite presumptive acute LV unloading.

Original languageEnglish (US)
Pages (from-to)1257-1263
Number of pages7
JournalAmerican Journal of Cardiology
Volume114
Issue number8
DOIs
StatePublished - Oct 15 2014

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Natriuretic Peptides
Heart-Assist Devices
Brain Natriuretic Peptide
Heart Failure
Ambulatory Surgical Procedures
Tertiary Care Centers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Early trends in N-terminal pro-brain natriuretic peptide values after left ventricular assist device implantation for chronic heart failure. / Hasin, Tal; Kushwaha, Sudhir S.; Lesnick, Timothy G.; Kremers, Walter K; Boilson, Barry A.; Schirger, John A.; Clavell, Alfredo L.; Rodeheffer, Richard J.; Frantz, Robert; Edwards, Brooks Sayre; Pereira, Naveen Luke; Stulak, John M.; Joyce, Lyle; Daly, Richard; Park, Soon J.; Jaffe, Allan S.

In: American Journal of Cardiology, Vol. 114, No. 8, 15.10.2014, p. 1257-1263.

Research output: Contribution to journalArticle

Hasin, Tal ; Kushwaha, Sudhir S. ; Lesnick, Timothy G. ; Kremers, Walter K ; Boilson, Barry A. ; Schirger, John A. ; Clavell, Alfredo L. ; Rodeheffer, Richard J. ; Frantz, Robert ; Edwards, Brooks Sayre ; Pereira, Naveen Luke ; Stulak, John M. ; Joyce, Lyle ; Daly, Richard ; Park, Soon J. ; Jaffe, Allan S. / Early trends in N-terminal pro-brain natriuretic peptide values after left ventricular assist device implantation for chronic heart failure. In: American Journal of Cardiology. 2014 ; Vol. 114, No. 8. pp. 1257-1263.
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AU - Hasin, Tal

AU - Kushwaha, Sudhir S.

AU - Lesnick, Timothy G.

AU - Kremers, Walter K

AU - Boilson, Barry A.

AU - Schirger, John A.

AU - Clavell, Alfredo L.

AU - Rodeheffer, Richard J.

AU - Frantz, Robert

AU - Edwards, Brooks Sayre

AU - Pereira, Naveen Luke

AU - Stulak, John M.

AU - Joyce, Lyle

AU - Daly, Richard

AU - Park, Soon J.

AU - Jaffe, Allan S

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N2 - Left ventricular assist devices (LVADs) acutely decrease left ventricular wall stress. Thus, early postoperative levels of N-terminal proebrain natriuretic peptide (NT-proBNP) should decrease. This study investigated postoperative changes in NT-proBNP levels, the parameters related to changes, and the possible association with complications by performing a retrospective analysis of changes in daily NT-proBNP (pg/ml) levels from admission to discharge both before and after LVAD implantation in a tertiary referral center. For 72 patients implanted with HeartMate II LVADs, baseline NT-proBNP levels were elevated at 3,943 ng/ml (interquartile range 1,956 to 12,964). Preoperative stabilization led to marked decreases in NT-proBNP. Levels peaked 3 days after surgery and subsequently decreased. Patients with complicated postoperative courses had higher early postoperative elevations. By discharge, NT-proBNP decreased markedly but was still 2.83 (1.60 to 5.76) times the age-based upper limit of normal. The 26% reduction in NT-proBNP between admission and discharge was due mostly to the preoperative reductions and not those induced by the LVAD itself. The decrease was not associated with decreases in LV volume. In conclusion, preoperative treatment reduces NT-proBNP values. The magnitude of early postoperative changes is related to the clinical course. Levels at discharge remain markedly elevated and similar to values after preoperative stabilization despite presumptive acute LV unloading.

AB - Left ventricular assist devices (LVADs) acutely decrease left ventricular wall stress. Thus, early postoperative levels of N-terminal proebrain natriuretic peptide (NT-proBNP) should decrease. This study investigated postoperative changes in NT-proBNP levels, the parameters related to changes, and the possible association with complications by performing a retrospective analysis of changes in daily NT-proBNP (pg/ml) levels from admission to discharge both before and after LVAD implantation in a tertiary referral center. For 72 patients implanted with HeartMate II LVADs, baseline NT-proBNP levels were elevated at 3,943 ng/ml (interquartile range 1,956 to 12,964). Preoperative stabilization led to marked decreases in NT-proBNP. Levels peaked 3 days after surgery and subsequently decreased. Patients with complicated postoperative courses had higher early postoperative elevations. By discharge, NT-proBNP decreased markedly but was still 2.83 (1.60 to 5.76) times the age-based upper limit of normal. The 26% reduction in NT-proBNP between admission and discharge was due mostly to the preoperative reductions and not those induced by the LVAD itself. The decrease was not associated with decreases in LV volume. In conclusion, preoperative treatment reduces NT-proBNP values. The magnitude of early postoperative changes is related to the clinical course. Levels at discharge remain markedly elevated and similar to values after preoperative stabilization despite presumptive acute LV unloading.

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