Work

Prognostic value of NT-proBNP monitoring in patients with left ventricular assist devices

Year: 2025

Type: article

Abstract: Background NT-proBNP is a well-established biomarker in heart failure; however, its prognostic value in patients supported by left ventricular assist devices (LVAD) remains unclear. Objectives This study aimed to assess the association between NT-proBNP levels and hemodynamic parameters as well as clinical outcomes at 1 year in LVAD recipients. Methods We conducted a retrospective cohort study including patients implanted with a LVAD between 2008 and 2025 at two tertiary care centers. NT-proBNP levels were measured at 3- and 6-months post-implantation, and their relationships with invasive hemodynamic parameters and 1-year clinical outcomes were evaluated at each time points. Results A total of 128 patients were included. Whereas NT-proBNP measured at 3 months showed no significant correlation with any hemodynamic parameters, NT-proBNP at 6 months correlated with right atrial pressure (ρ=0.46, p < 0.01), systolic pulmonary artery pressure (ρ=0.39, p=0.03), and pulmonary capillary wedge pressure (ρ=0.39, p=0.02). NT-proBNP measured at 3 months was not significantly associated with 1-year mortality, pump thrombosis, or right ventricular (RV) failure. Conversely, NT-proBNP at 6 months was independently associated with an increased risk of the composite endpoint of mortality or pump thrombosis (aHR 1.34 [1.07–1.62] per 500 pg/mL increase), and the composite endpoint of mortality or RV failure (aOR 1.53 [1.17–2.01] per 500 pg/mL increase). Conclusion NT-proBNP measured at 6 months post-LVAD implantation is a significant predictor of adverse clinical and hemodynamic outcomes at 1 year, supporting its role in risk stratification. Prospective studies are warranted to validate these findings. CONDENSED ABSTRACT After LVAD implantation, NT-proBNP levels tend to progressively decrease over time. Although early measurement at 3 months is not correlated with hemodynamic parameters or clinical outcomes, NT-proBNP at 6 months is significantly correlated with pressure-related hemodynamic parameters (right and left heart congestion) but not with cardiac output/index, and was associated with clinical outcomes such as all-cause mortality, pump thrombosis, and RV failure at 1-year. NT-proBNP monitoring beyond 6 months may be valuable for long-term follow-up and risk stratification in LVAD patients.

Source: JHLT Open

DOI: 10.1016/j.jhlto.2025.100387