Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Peptides. 2021 Jan;135:170420. doi: 10.1016/j.peptides.2020.170420. Epub 2020 Oct 13.
The clinical significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients undergoing left ventricular assist device (LVAD) implantation is not fully explored. NT-proBNP concentrations are influenced by body composition, renal function and intracardiac pressures; dynamic measures pre- and post-LVAD implantation. We sought to identify the individual contribution of cardiac and extracardiac factors to NT-proBNP concentrations in advanced heart failure patients before and after LVAD implantation. We retrospectively collected data from 63 patients implanted with a LVAD with NT -proBNP measurements (2006-2019). Hemodynamic measurements were obtained through right heart catheterization (RHC). Univariable linear regression and multivariable stepwise regression models were used to analyze variables associated with NT-proBNP concentrations in the pre- and post-LVAD setting. Paired t-test was performed on a subpopulation of 13 patients with complete data. We found significant differences in all extracardiac (BMI, creatinine, eGFR) and all invasive hemodynamic measurements pre-LVAD compared to post-LVAD. NT-proBNP decreased by 83 %, in the subpopulation of 13 patients: 736 pmol/L [IQR 498-1330] to 126 pmol/L [IQR 74.8-241.7]. In multivariable analysis, only creatinine remained significantly associated with NT-proBNP before LVAD implant (p = 0.016), whereas pulmonary capillary wedge pressure (PCWP) was the only independent variable associated with NT-proBNP after LVAD implant (p < 0.0001). Creatinine and PCWP were the only independent factors associated with NT-proBNP concentrations before and after LVAD implantation, respectively. Invasive hemodynamic measurements were more closely associated with NT-proBNP concentration after LVAD than extracardiac factors and reversely pre-LVAD, suggesting that NT-proBNP serves as a useful biomarker of cardiac conditions post-LVAD implantation.
左心室辅助装置 (LVAD) 植入患者中 N 端脑利钠肽前体 (NT-proBNP) 的临床意义尚未充分探索。NT-proBNP 浓度受身体成分、肾功能和心内压的影响；LVAD 植入前后的动态测量。我们试图确定在 LVAD 植入前后，心脏和心脏外因素对晚期心力衰竭患者 NT-proBNP 浓度的个体贡献。我们回顾性地收集了 63 例 LVAD 植入患者的 NT-proBNP 测量数据（2006-2019 年）。通过右心导管检查 (RHC) 获得血流动力学测量值。使用单变量线性回归和多变量逐步回归模型分析与 LVAD 植入前后 NT-proBNP 浓度相关的变量。对 13 例具有完整数据的亚组进行配对 t 检验。我们发现与 LVAD 后相比，LVAD 前所有心脏外因素（BMI、肌酐、eGFR）和所有有创血流动力学测量均有显著差异。在 13 例具有完整数据的亚组中，NT-proBNP 下降 83%：736 pmol/L [IQR 498-1330] 至 126 pmol/L [IQR 74.8-241.7]。多变量分析显示，仅肌酐在 LVAD 植入前与 NT-proBNP 显著相关（p = 0.016），而肺动脉楔压 (PCWP) 是 LVAD 植入后与 NT-proBNP 唯一独立相关的变量（p < 0.0001）。肌酐和 PCWP 分别是 LVAD 植入前后与 NT-proBNP 浓度相关的唯一独立因素。LVAD 后，侵入性血流动力学测量与 NT-proBNP 浓度的相关性比心脏外因素更密切，而 LVAD 前则相反，这表明 NT-proBNP 是 LVAD 植入后心脏状况的有用生物标志物。
