Abstract
Left ventricular assist devices (LVADs) have been representing a cornerstone therapy for patients with end-stage heart failure during the last decades. However, their use induces several pathophysiological modifications which are partially responsible for the complications that typically characterize these patients, such as right ventricular failure, thromboembolic events, as well as bleedings. During the last years, biomarkers involved in the pathways of neurohormonal activation, myocardial injury, adverse remodeling, oxidative stress and systemic inflammation have raised attention. The search and analysis of potential biomarkers in LVAD patients could lead to the identification of a subset of patients with an increased risk of developing these adverse events. This could then promote a closer follow-up as well as therapeutic modifications. Furthermore, it might highlight some new therapeutic pharmacological targets that could lead to improved long-term survival. The aim of this review is to provide current evidence on the role of different biomarkers in patients with LVAD, in particular highlighting their possible implications in clinical practice.
Highlights
Left ventricular assist devices (LVADs) have been representing a cornerstone therapy for patients with end-stage heart failure (HF) during the last decades, being able to face the growing shortage of heart donations on one hand and on the other hand to serve as an alternative in presence of contraindications to a heart transplant, that to date remains the gold standard [1]
We included the most studied and available markers in LVAD patients, and provided an overview of novel and original biomarkers, even though their actual use we provided an overview of novel and original biomarkers, even though their actual in clinical practice is still marginal
LVAD patients represent a fragile population, susceptible to several complications both in the short, medium- and long-term, attributable to pathophysiological modifications induced by continuous flow, to the characteristics of the device and its biocompatibility, as well as the required anti-thrombotic therapy
Summary
Left ventricular assist devices (LVADs) have been representing a cornerstone therapy for patients with end-stage heart failure (HF) during the last decades, being able to face the growing shortage of heart donations on one hand and on the other hand to serve as an alternative in presence of contraindications to a heart transplant, that to date remains the gold standard [1]. Despite a progressive improvement of LVAD patients’ survival, the medium- and long-term follow-up is jeopardized by a series of complications that have a great impact on prognoses, such as right ventricular failure, bleedings and thromboembolic events [2,3]. Four patterns of biomarkers are here reported, with a brief description for each subgroup of the following: endothelium-, fibrosis-, inflammation-related markers and neurohormones. LVAD, left ventricular assistance device; device; NT-proBNP, N-terminal fragment of precursor of. We included the most studied and available markers in LVAD patients, and provided an overview of novel and original biomarkers, even though their actual use we provided an overview of novel and original biomarkers, even though their actual in clinical practice is still marginal. HF and post-LVAD implantation, despite drivers for their activation may consistently differ
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