title: Neurohumoral and inflammatory markers for prediction of right ventricular failure after implantation of a left ventricular assist device.
abstract: OBJECTIVE
  Implantation of a left ventricular assist device (LVAD) is an established treatment for end-stage heart failure. Right ventricular dysfunction develops in 20%-50% of patients after device implantation, leading to prolonged hospital stays and elevated mortality rates. However, prediction of right ventricular failure remains difficult.
  
  
  METHODS
  A total of 40 patients who received an LVAD for chronic end-stage heart failure between May 2001 and December 2002 were evaluated. The patients were divided retrospectively into two groups: group I (n = 26), with no apparent postoperative right ventricular failure; and group II (n = 14), with right ventricular failure after implantation defined by the presence of two of the following criteria during the first week after surgery: mean arterial pressure ≤ 55 mmHg, central venous pressure ≥ 16 mmHg, mixed venous saturation ≤ 55%, cardiac index <2 l/min/m(2), inotropic support score >20 units or an apparent need for mechanical right ventricular support. Hemodynamic, echocardiographic, neurohumoral, and inflammatory parameters were evaluated 24 h before implantation of the LVAD.
  
  
  RESULTS
  Levels of procalcitonin, neopterin, n-terminalpro-brain natriuretic peptide, and big endothelin-1 were significantly lower in group I: 0.106 vs. 0.322 ng/ml, P = 0.048; 10.5 vs. 20.7 ng/ml, P = 0.018; 6322 vs. 17174 pg/ml, P = 0.032; 1.6 vs. 19.5 pg/ml, P = 0.02, respectively. Levels of creatinine kinase and creatinine were significantly lower in group I than in group II: 24 vs. 40 U/l, P = 0.034; 1.3 vs. 2.3 mg/dl, P = 0.008, respectively.
  
  
  CONCLUSIONS
  Preoperative evaluation of markers of inflammation and neurohumoral activation may provide additional information for predicting right ventricular failure after implantation of an LVAD.
authors.affiliation: Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany. fhennig@dhzb.de
authors.forename: Felix
authors.initials: F
authors.lastname: Hennig
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Stepanenko
authors.forename: Hans B
authors.initials: HB
authors.lastname: Lehmkuhl
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.forename: Michael
authors.initials: M
authors.lastname: Dandel
authors.forename: Thomas
authors.initials: T
authors.lastname: Krabatsch
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Evgenij V
authors.initials: EV
authors.lastname: Potapov
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D036361:Peptide Hormones / Q000097:blood*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D036361:Peptide Hormones