Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review.

Eva Janssen,Saskia L M A Beeres,J Wouter Jukema,Martin J Schalij,Laurens F Tops

doi:10.3389/fcvm.2021.699492

Abstract

Aims: Major adverse event (MAE) rates during left ventricular assist device (LVAD) therapy in advanced heart failure (HF) patients are high, and impair quality of life and survival. Prediction and risk stratification of MAEs in order to improve patient selection and thereby outcome during LVAD therapy is therefore warranted. Circulating natriuretic peptides (NPs) are strong predictors of MAEs and mortality in chronic HF patients. However, whether NPs can identify patients who are at risk of MAEs and mortality or tend toward myocardial recovery after LVAD implantation is unclear. The aim of this systematic review is to analyze the prognostic value of circulating NP levels before LVAD implantation for all-cause mortality, MAEs and myocardial recovery after LVAD implantation.Methods and Results: Electronic databases were searched for studies analyzing circulating NP in adults with advanced HF before LVAD implantation in relation to mortality, MAEs, or myocardial recovery after LVAD implantation. Twenty-four studies published between 2008 and 2021 were included. Follow-up duration ranged from 48 hours to 5 years. Study sample size ranged from 14 to 15,138 patients. Natriuretic peptide levels were not predictive of all-cause mortality. However, NPs were predictive of right ventricular failure (RVF) and MAEs such as ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization. No relation between NPs and myocardial recovery was found.Conclusion: This systematic review found that NP levels before LVAD implantation are not predictive of all-cause mortality after LVAD implantation. Thus, NP levels may be of limited value in patient selection for LVAD therapy. However, NPs help in risk stratification of MAEs and may be used to identify patients who are at risk for RVF, ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization after LVAD implantation.

Highlights

The prognosis of advanced heart failure (HF) is poor, with annual mortality rates over 50%, and limited treatment options (1)
In the study of Shiga et al it was demonstrated that B-type natriuretic peptide (BNP) levels ≥1,200 pg/ml were not predictive of right ventricular failure (RVF), while in the study by Kato et al BNP levels ≥1,232 ng/ml were an independent predictor of RVF after 2–14 days (34, 35)
This systematic review demonstrates that BNP levels before Left ventricular assist devices (LVADs) implantation are not predictive of all-cause mortality after LVAD implantation

Summary

Introduction

The prognosis of advanced heart failure (HF) is poor, with annual mortality rates over 50%, and limited treatment options (1). Patient selection and timing of LVAD implantation is guided by the profiles of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) classifying patients with advanced heart failure (2). Major adverse event (MAE) and rehospitalization rates are high, and impair quality of life and survival (4, 5). These MAEs include neurologic event (defined as stroke or transient ischemic attack), gastrointestinal bleeding, major infection, and right heart failure (RVF) occurring 13–20, 20–25, 40–43, and 29–38% at 1 year after CF-LVAD implantation, respectively (4). Treatment options for MAEs are limited and often ineffective, having corresponding high mortality rates. Measurement of circulating biomarkers such as natriuretic peptides (NPs) may help in risk stratification

Results

Discussion

Conclusion