A MULTI-CENTRE STUDY EXAMINING THE ASSOCIATION BETWEEN NATRIURETIC PEPTIDES AND MORTALITY IN PATIENTS WITH A LEFT VENTRICULAR ASSIST DEVICE

Abstract

BACKGROUND In patients with advanced heart failure, a left ventricular assist device (LVAD) offers improved survival and quality of life. NTproBNP is commonly measured during routine follow-up in patients with a LVAD. While NTproBNP has been extensively studied in ambulatory heart failure patients, and proven a useful prognostic marker, there is scarce evidence on its prognostic utility in LVAD patients. This multi-centre study aims to evaluate the association between NTproBNP and mortality in patients with a LVAD as bridge to heart transplant or destination therapy. METHODS AND RESULTS This is a two-center retrospective cohort study including 165 consecutive adults discharged after implantation of a durable continuous flow LVAD either as bridge to heart transplant, or as destination therapy between 2006 and 2020 at the Toronto General Hospital (Toronto, ON) and the Rigshospitalet (Copenhangen, Denmark). Uni- and multi-variable extended Cox proportional hazard models were used to evaluate the association between multiple measures of NTproBNP and mortality in LVAD patients. Of the 165 patients included in the analysis, 84 patients died and 76 patients were successfully bridged to heart transplant. Multi-variable analysis were adjusted for age, gender, type of cardiomyopathy, hypertension and diabetes. There was an increasing mortality risk with increasing NTproBNP values (Figure), with a significantly increased risk in patients with NTproBNP >1600 pmol/L in comparison to < 400 pmol/L (HR 4.4, CI 2.1-10.0). CONCLUSION Our multi-centre study demonstrates that in patients with a LVAD for bridge to transplantation or destination therapy, NTproBNP values exceeding 1600 pmol/L are significantly associated with increased risk of mortality. Larger studies may be useful to examine the prognostic utility of lower levels of NTproBNP and its association with mortality or heart-failure related hospitalizations. In patients with advanced heart failure, a left ventricular assist device (LVAD) offers improved survival and quality of life. NTproBNP is commonly measured during routine follow-up in patients with a LVAD. While NTproBNP has been extensively studied in ambulatory heart failure patients, and proven a useful prognostic marker, there is scarce evidence on its prognostic utility in LVAD patients. This multi-centre study aims to evaluate the association between NTproBNP and mortality in patients with a LVAD as bridge to heart transplant or destination therapy. This is a two-center retrospective cohort study including 165 consecutive adults discharged after implantation of a durable continuous flow LVAD either as bridge to heart transplant, or as destination therapy between 2006 and 2020 at the Toronto General Hospital (Toronto, ON) and the Rigshospitalet (Copenhangen, Denmark). Uni- and multi-variable extended Cox proportional hazard models were used to evaluate the association between multiple measures of NTproBNP and mortality in LVAD patients. Of the 165 patients included in the analysis, 84 patients died and 76 patients were successfully bridged to heart transplant. Multi-variable analysis were adjusted for age, gender, type of cardiomyopathy, hypertension and diabetes. There was an increasing mortality risk with increasing NTproBNP values (Figure), with a significantly increased risk in patients with NTproBNP >1600 pmol/L in comparison to < 400 pmol/L (HR 4.4, CI 2.1-10.0). Our multi-centre study demonstrates that in patients with a LVAD for bridge to transplantation or destination therapy, NTproBNP values exceeding 1600 pmol/L are significantly associated with increased risk of mortality. Larger studies may be useful to examine the prognostic utility of lower levels of NTproBNP and its association with mortality or heart-failure related hospitalizations.