Hellman Yaron, Malik Adnan S, Lin Hongbo, Shen Changyu, Wang I-Wen, Wozniak Thomas C, Hashmi Zubair A, Pickrell Jeanette, Jani Milena, Caccamo Marco A, Gradus-Pizlo Irmina, Hadi Azam
Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics, IU School of Medicine, Indianapolis, IN, USA.
Artif Organs. 2015 Dec;39(12):1051-5. doi: 10.1111/aor.12486. Epub 2015 Apr 10.
B-type natriuretic peptide (BNP) levels have been shown to predict ventricular arrhythmia (VA) and sudden death in patients with heart failure. We sought to determine whether BNP levels before left ventricular assist device (LVAD) implantation can predict VA post LVAD implantation in advanced heart failure patients. We conducted a retrospective study consisting of patients who underwent LVAD implantation in our institution during the period of May 2009-March 2013. The study was limited to patients receiving a HeartMate II or HeartWare LVAD. Acute myocardial infarction patients were excluded. We compared between the patients who developed VA within 15 days post LVAD implantation to the patients without VA. A total of 85 patients underwent LVAD implantation during the study period. Eleven patients were excluded (five acute MI, four without BNP measurements, and two discharged earlier than 13 days post LVAD implantation). The incidence of VA was 31%, with 91% ventricular tachycardia (VT) and 9% ventricular fibrillation. BNP remained the single most powerful predictor of VA even after adjustment for other borderline significant factors in a multivariate logistic regression model (P < 0.05). BNP levels are a strong predictor of VA post LVAD implantation, surpassing previously described risk factors such as age and VT in the past.
B型利钠肽（BNP）水平已被证明可预测心力衰竭患者的室性心律失常（VA）和猝死。我们试图确定在植入左心室辅助装置（LVAD）前的BNP水平是否能预测晚期心力衰竭患者LVAD植入术后的VA。我们进行了一项回顾性研究，研究对象为2009年5月至2013年3月期间在我们机构接受LVAD植入的患者。该研究仅限于接受HeartMate II或HeartWare LVAD的患者。急性心肌梗死患者被排除在外。我们比较了LVAD植入术后15天内发生VA的患者与未发生VA的患者。在研究期间，共有85例患者接受了LVAD植入。11例患者被排除（5例急性心肌梗死，4例未测量BNP，2例在LVAD植入术后13天前出院）。VA的发生率为31%，其中室性心动过速（VT）占91%，心室颤动占9%。在多变量逻辑回归模型中，即使在对其他临界显著因素进行调整后，BNP仍然是VA最有力的单一预测因子（P < 0.05）。BNP水平是LVAD植入术后VA的有力预测因子，超过了既往描述的诸如年龄和既往VT等危险因素。
