(843) Change in NT-ProBNP to Predict Development of Right, Left, and Biventricular Heart Failure in Heartmate 3 LVAD Patients

PurposeB-type natriuretic peptide (BNP) has been used as a prognostic tool to assess the degree of left ventricular (LV) unloading in patients supported by continuous-flow LV assist devices (LVAD). Studies have shown that BNP levels normalize between 30 to 60 days post-LVAD implantation. No previous studies have shown an association between persistent BNP elevation and late RHF in LVAD patients. The aim of this study is to analyze the change in the NT-proBNP (N-terminal proBNP) levels and its association with development of right heart failure (RHF) 30-days post LVAD (late RHF), inadequate LV unloading or biventricular failure.MethodsFifty-eight patients who underwent Heartmate3 LVAD implantation from June 2015 to November 2021 were eligible for review. A total of 41 were included in analysis after excluding deaths during the implant admission or with end-stage renal disease. Late RHF was defined using the mechanical circulatory support academic research consortium consensus. Left Heart Failure (LHF) was defined as PCWP ≥ 18mmHg on right heart catheterization. NT-proBNP was calculated as the percent change from pre-LVAD to 6 months post-LVAD.ResultsOf the 41 patients reviewed, 16 developed evidence of RHF, 11 of LFH, and 7 of biventricular failure. Increased NT-proBNP was associated with an increased odds ratio of developing RHF (5.7, 95% CI 1.2 - 27.1, p=0.029). There was no significant increase in the odds of developing LHF (0.63, 95% CI 0.10 - 3.78, p=0.61) or biventricular failure (3.3, 96% CI 0.55 - 19.7, p=0.19). However, percent change in NT-proBNP was positively correlated with the magnitude of PCWP (p=0.016, R2=0.25).ConclusionPersistent elevation of NT-proBNP is a key tool for possible early recognition and identification of patients at risk of development RHF. However, further studies with a larger sample size are needed to externally validate our findings. The limitation of this study is inherent to a nonrandomized, retrospective study in a single center. B-type natriuretic peptide (BNP) has been used as a prognostic tool to assess the degree of left ventricular (LV) unloading in patients supported by continuous-flow LV assist devices (LVAD). Studies have shown that BNP levels normalize between 30 to 60 days post-LVAD implantation. No previous studies have shown an association between persistent BNP elevation and late RHF in LVAD patients. The aim of this study is to analyze the change in the NT-proBNP (N-terminal proBNP) levels and its association with development of right heart failure (RHF) 30-days post LVAD (late RHF), inadequate LV unloading or biventricular failure. Fifty-eight patients who underwent Heartmate3 LVAD implantation from June 2015 to November 2021 were eligible for review. A total of 41 were included in analysis after excluding deaths during the implant admission or with end-stage renal disease. Late RHF was defined using the mechanical circulatory support academic research consortium consensus. Left Heart Failure (LHF) was defined as PCWP ≥ 18mmHg on right heart catheterization. NT-proBNP was calculated as the percent change from pre-LVAD to 6 months post-LVAD. Of the 41 patients reviewed, 16 developed evidence of RHF, 11 of LFH, and 7 of biventricular failure. Increased NT-proBNP was associated with an increased odds ratio of developing RHF (5.7, 95% CI 1.2 - 27.1, p=0.029). There was no significant increase in the odds of developing LHF (0.63, 95% CI 0.10 - 3.78, p=0.61) or biventricular failure (3.3, 96% CI 0.55 - 19.7, p=0.19). However, percent change in NT-proBNP was positively correlated with the magnitude of PCWP (p=0.016, R2=0.25). Persistent elevation of NT-proBNP is a key tool for possible early recognition and identification of patients at risk of development RHF. However, further studies with a larger sample size are needed to externally validate our findings. The limitation of this study is inherent to a nonrandomized, retrospective study in a single center.