title: Early trends in N-terminal pro-brain natriuretic peptide values after left ventricular assist device implantation for chronic heart failure.
abstract: Left ventricular assist devices (LVADs) acutely decrease left ventricular wall stress. Thus, early postoperative levels of N-terminal pro-brain 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.
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: Hasintal@gmail.com.
authors.forename: Tal
authors.initials: T
authors.lastname: Hasin
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Lesnick
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Walter
authors.initials: W
authors.lastname: Kremers
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Boilson
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: John A
authors.initials: JA
authors.lastname: Schirger
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alfredo L
authors.initials: AL
authors.lastname: Clavell
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rodeheffer
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Frantz
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brooks S
authors.initials: BS
authors.lastname: Edwards
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.affiliation: Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lyle
authors.initials: L
authors.lastname: Joyce
authors.affiliation: Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Richard
authors.initials: R
authors.lastname: Daly
authors.affiliation: Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.affiliation: William J von Liebig Transplant Center, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain