A two-centre study investigating the association between brain natriuretic peptides & outcomes in continuous flow left ventricular assist device recipients.
Maria Lambadaris, Farid Foroutan, Julie Kk Vishram-Nielsen, Marie Sophie S Knudsen, Filio Billia, Vivek Rao, Finn Gustafsson, Ana C Alba
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引用次数: 0
Abstract
Background: Natriuretic peptides are useful prognostic markers in patients with heart failure and this study aims to evaluate the association between N-terminal pro-brain natriuretic peptide and outcomes in patients with a continuous-flow left ventricular assist device.
Methods: Adult patients with a continuous-flow left ventricular assist device as bridge to transplant or destination therapy and discharged from hospital were included in the study. Multi-variable Cox regression models with natriuretic peptide as a time-dependent covariate modelling multiple measures per patient, and cubic spline analysis were used to evaluate the association between natriuretic peptides and patient outcomes, taking median N-terminal pro-brain natriuretic peptide of 244 pmol/L as the reference value. Heart transplant was considered a competing event for mortality analysis, while death was considered a competing event for transplantation analysis. A multivariable cause-specific Cox regression model evaluated the relationship between natriuretic peptides and heart failure hospitalizations while considering heart failure hospitalizations as recurring events and adjusting for competing risks of death and transplant.
Results: This retrospective cohort study included 161 adults. During a median follow-up of 4.7 years, 49 patients died, 79 received a heart transplant and 66 were hospitalized for heart failure. In comparison to the median N-terminal pro-brain natriuretic peptide level, patients exceeding 350 pmol/L had a 19% increased mortality (HR 1.19, 95%CI 1.01-1.15) while patients exceeding 330 pmol/L had a 16% higher risk of hospitalization (HR 1.16, 95%CI 1.01-1.12).
Conclusion: In patients with a continuous-flow left ventricular assist device, serial assessments of natriuretic peptides may help provide personalized patient care.
期刊介绍:
Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields.
Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials.
Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.