Body mass index and natriuretic peptides trends before and after left ventricular assist device

Abstract

AbstractBackgroundIt is unknown to what degree of sarcopenia related to heart failure (HF) is reversible with resolution of the HF syndrome. We evaluated whether (1) weight loss prior to left ventricular assist device (LVAD) is associated with pre‐operative sarcopenia as quantified on pre‐operative chest CTs and (2) determine the relationship between weight recovery (increase) after LVAD implantation and reduction of NT‐proBNP levels.MethodsIn a large single‐centre cohort (n = 502), CT measures of sarcopenia (pectoralis muscle mass indexed to body surface area and tissue attenuation) were correlated with pre‐LVAD BMI trend (n = 190). BMI and NT‐proBNP trends before and after LVAD implantation were evaluated (n = 403). Linear effects modelling was performed to test the association between NT‐proBNP and BMI trends.ResultsA downtrending BMI prior to LVAD was associated with pectoralis muscle tissue attenuation (P < 0.05). BMI declined prior to LVAD, declined further early post‐implant, and then increased between 100 and 300 days post‐implant (average per cent change in BMI in Year 1, 7.6%, 95% CI: 6.3–8.8%). NT‐proBNP decreased during the first 100 post LVAD days (−5.4%, 95% CI: −6.6 to −4.2%). Post‐LVAD NT‐proBNP and BMI trends were significantly associated, with a decrease of 1 unit log NT‐proBNP associated with an increase in BMI of 0.81 kg/m2 (CI: 0.53–1.09, P < .001). The rise in post‐LVAD BMI occurred after the reduction in NT‐proBNP levels. Patients who failed to gain weight post‐LVAD had the highest 6‐month post‐LVAD natriuretic peptides (lowest per cent BMI gain tertile NT‐proBNP: 2208 vs. highest 1635 pg/mL, P < 0.001).ConclusionsWeight recovery during LVAD support occurs after the reduction in natriuretic peptide levels. Failure to gain weight during LVAD support was associated with persistently elevated natriuretic peptide levels. These data collectively suggest that recovery of body mass may be dependent upon recovery of the HF syndrome.