BACKGROUND
In patients with advanced heart failure, a left ventricular assist device (LVAD) offers
improved survival and quality of life. NTproBNP is commonly measured during routine
follow-up in patients with a LVAD. While NTproBNP has been extensively studied in
ambulatory heart failure patients, and proven a useful prognostic marker, there is
scarce evidence on its prognostic utility in LVAD patients. This multi-centre study
aims to evaluate the association between NTproBNP and mortality in patients with a
LVAD as bridge to heart transplant or destination therapy.
METHODS AND RESULTS
This is a two-center retrospective cohort study including 165 consecutive adults discharged
after implantation of a durable continuous flow LVAD either as bridge to heart transplant,
or as destination therapy between 2006 and 2020 at the Toronto General Hospital (Toronto,
ON) and the Rigshospitalet (Copenhangen, Denmark). Uni- and multi-variable extended
Cox proportional hazard models were used to evaluate the association between multiple
measures of NTproBNP and mortality in LVAD patients. Of the 165 patients included
in the analysis, 84 patients died and 76 patients were successfully bridged to heart
transplant. Multi-variable analysis were adjusted for age, gender, type of cardiomyopathy,
hypertension and diabetes. There was an increasing mortality risk with increasing
NTproBNP values (Figure), with a significantly increased risk in patients with NTproBNP
>1600 pmol/L in comparison to < 400 pmol/L (HR 4.4, CI 2.1-10.0).
CONCLUSION
Our multi-centre study demonstrates that in patients with a LVAD for bridge to transplantation
or destination therapy, NTproBNP values exceeding 1600 pmol/L are significantly associated
with increased risk of mortality. Larger studies may be useful to examine the prognostic
utility of lower levels of NTproBNP and its association with mortality or heart-failure
related hospitalizations.
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© 2021 Published by Elsevier Inc.
