title: Serum Brain Natriuretic Peptide Concentration 60 Days After Surgery as a Predictor of Long-Term Prognosis in Patients Implanted With a Left Ventricular Assist Device.
abstract: Mechanical circulatory support by a left ventricular assist device (LVAD) is used to bridge patients with advanced heart failure to transplant or as a definitive treatment. We retrospectively sought predictors of long-term outcome in a cohort of 83 patients who had undergone LVAD treatment. We subjected perioperative clinical data of patients to statistical analysis to establish parameters associated with all-cause mortality, and the cutoff values, sensitivity, and specificity of those that had a statistically significant relation with survival. Mean follow-up was 717 days (standard deviation, 334 days; range, 17-1,592 days). Fourteen patients (16.8%) died, but nine (10.8%) were weaned from support. Serum brain natriuretic peptide (BNP) concentration measured 60 days after implantation was significantly associated with all-cause mortality. The optimal BNP cutoff value to predict death during LVAD support was 322 pg/ml, with a sensitivity of 71.4% and specificity of 79.8%. Two-year survival was 92.0% in those with 60 days serum BNP concentration <322 pg/ml compared with 70.5% in those in whom it was ≥322 pg/ml (p = 0.003). The relation between BNP and survival likely reflects recovery of native myocardial function and improvements in global health and should assist clinicians in the on-going management of long-term LVAD therapy.
authors.affiliation: From the *Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; †Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; and ‡Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Sato
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Iwashima
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.forename: Seiko
authors.initials: S
authors.lastname: Nakajima
authors.forename: Michinari
authors.initials: M
authors.lastname: Hieda
authors.forename: Takuya
authors.initials: T
authors.lastname: Watanabe
authors.forename: Haruki
authors.initials: H
authors.lastname: Sunami
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Murata
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain