Relationship between NT-pro Brain Natriuretic Peptide and Filling Pressures in Ambulatory Patients with Left Ventricular Assist Devices and Accuracy to Detect Need for Optimization

Abstract

We examined whether N-terminal pro-brain natriuretic peptide (NT-proBNP) can serve as a noninvasive marker of filling pressures in ambulatory patients with continuous flow left ventricular assist devices. We retrospectively identified patients who had an outpatient right heart catheterization and NT-proBNP performed the same day between 01/01/2012 and 12/18/2018 at our institution. We evaluated the correlations between NT- proBNP and right atrial pressure (RA), pulmonary artery pressure (PA) and pulmonary capillary wedge pressure (PCWP). The best cut off for NT-proBNP to predict patients that were hemodynamically optimized (CVP<15 and PCWP<18) was derived as the value that minimized the square of the difference between sensitivity and specificity RESULTS: A total of 40 patients were included in the study, Patients characteristics are shown in Table 1. The median NT-proBNP was 1114 pg/mL(IQR 553-2056). The correlations between NT-proBNP and RA (r = 0.58;p<0.001; Coefficient of variation (CV) = 37%); PA(r = 0.34;p=0.03; CV = 26%) and PCWP (r = 0.45;p=0.004; CV = 32%) are shown in figure 1 panels A, B and C respectively. NT-proBNP ≥1168 pg/mL had a 60 %sensitivity and 61% specificity in identifying non-optimum hemodynamics.(Figure 1 panel D). NT-proBNP level is elevated in ambulatory patients with continuous flow left ventricular assist devices and has a moderate correlation with filling pressures. The best cutoff value identified to predict need of hemodynamic optimization had low sensitivity and specificity.