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Serum Brain Natriuretic Peptide Concentration 60 Days After Surgery as a Predictor of Long-Term Prognosis in Patients Implanted With a Left Ventricular Assist Device.

Sato T, Seguchi O, Iwashima Y, Yanase M, Nakajima S, Hieda M, Watanabe T, Sunami H, Murata Y, Hata H, Fujita T, Kobayashi J, Nakatani T - ASAIO J. (2015 Jul-Aug)

Bottom Line: We subjected perioperative clinical data of patients to statistical analysis to establish parameters associated with all-cause mortality, and the cutoff values, sensitivity, and specificity of those that had a statistically significant relation with survival.Serum brain natriuretic peptide (BNP) concentration measured 60 days after implantation was significantly associated with all-cause mortality.Two-year survival was 92.0% in those with 60 days serum BNP concentration <322 pg/ml compared with 70.5% in those in whom it was ≥322 pg/ml (p = 0.003).

View Article: PubMed Central - PubMed

Affiliation: From the *Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; †Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; and ‡Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

ABSTRACT
Mechanical circulatory support by a left ventricular assist device (LVAD) is used to bridge patients with advanced heart failure to transplant or as a definitive treatment. We retrospectively sought predictors of long-term outcome in a cohort of 83 patients who had undergone LVAD treatment. We subjected perioperative clinical data of patients to statistical analysis to establish parameters associated with all-cause mortality, and the cutoff values, sensitivity, and specificity of those that had a statistically significant relation with survival. Mean follow-up was 717 days (standard deviation, 334 days; range, 17-1,592 days). Fourteen patients (16.8%) died, but nine (10.8%) were weaned from support. Serum brain natriuretic peptide (BNP) concentration measured 60 days after implantation was significantly associated with all-cause mortality. The optimal BNP cutoff value to predict death during LVAD support was 322 pg/ml, with a sensitivity of 71.4% and specificity of 79.8%. Two-year survival was 92.0% in those with 60 days serum BNP concentration <322 pg/ml compared with 70.5% in those in whom it was ≥322 pg/ml (p = 0.003). The relation between BNP and survival likely reflects recovery of native myocardial function and improvements in global health and should assist clinicians in the on-going management of long-term LVAD therapy.

No MeSH data available.


Related in: MedlinePlus

Patient survival after left ventricular assist device (LVAD) implantation. Red, patients with 60 days postoperative brain natriuretic peptide (BNP) concentration ≥322 pg/ml; blue, patients with 60 days postoperative BNP concentration <322 pg/ml. Survival was significantly better in those patients with 60 days postoperative BNP concentration <322 pg/ml (p = 0.003).
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Figure 3: Patient survival after left ventricular assist device (LVAD) implantation. Red, patients with 60 days postoperative brain natriuretic peptide (BNP) concentration ≥322 pg/ml; blue, patients with 60 days postoperative BNP concentration <322 pg/ml. Survival was significantly better in those patients with 60 days postoperative BNP concentration <322 pg/ml (p = 0.003).

Mentions: Comparison of the Kaplan–Meier curves of patients with an LVAD with BNP concentration <322 pg/ml and those with a BNP concentration ≥322 pg/ml 60 days after implantation showed that a significantly greater proportion of the group with the lower BNP concentration were alive 2 years after surgery. At 6 months, survival was 100% in both groups. At 1 year, survival was 98.5% and 96% in the low and high BNP groups, respectively. By 2 years, however, survival was 92.0% in the BNP <322 pg/ml group compared with 70.5% in the BNP ≥322 pg/ml group (p = 0.003; Figure 3).


Serum Brain Natriuretic Peptide Concentration 60 Days After Surgery as a Predictor of Long-Term Prognosis in Patients Implanted With a Left Ventricular Assist Device.

Sato T, Seguchi O, Iwashima Y, Yanase M, Nakajima S, Hieda M, Watanabe T, Sunami H, Murata Y, Hata H, Fujita T, Kobayashi J, Nakatani T - ASAIO J. (2015 Jul-Aug)

Patient survival after left ventricular assist device (LVAD) implantation. Red, patients with 60 days postoperative brain natriuretic peptide (BNP) concentration ≥322 pg/ml; blue, patients with 60 days postoperative BNP concentration <322 pg/ml. Survival was significantly better in those patients with 60 days postoperative BNP concentration <322 pg/ml (p = 0.003).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4487874&req=5

Figure 3: Patient survival after left ventricular assist device (LVAD) implantation. Red, patients with 60 days postoperative brain natriuretic peptide (BNP) concentration ≥322 pg/ml; blue, patients with 60 days postoperative BNP concentration <322 pg/ml. Survival was significantly better in those patients with 60 days postoperative BNP concentration <322 pg/ml (p = 0.003).
Mentions: Comparison of the Kaplan–Meier curves of patients with an LVAD with BNP concentration <322 pg/ml and those with a BNP concentration ≥322 pg/ml 60 days after implantation showed that a significantly greater proportion of the group with the lower BNP concentration were alive 2 years after surgery. At 6 months, survival was 100% in both groups. At 1 year, survival was 98.5% and 96% in the low and high BNP groups, respectively. By 2 years, however, survival was 92.0% in the BNP <322 pg/ml group compared with 70.5% in the BNP ≥322 pg/ml group (p = 0.003; Figure 3).

Bottom Line: We subjected perioperative clinical data of patients to statistical analysis to establish parameters associated with all-cause mortality, and the cutoff values, sensitivity, and specificity of those that had a statistically significant relation with survival.Serum brain natriuretic peptide (BNP) concentration measured 60 days after implantation was significantly associated with all-cause mortality.Two-year survival was 92.0% in those with 60 days serum BNP concentration <322 pg/ml compared with 70.5% in those in whom it was ≥322 pg/ml (p = 0.003).

View Article: PubMed Central - PubMed

Affiliation: From the *Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; †Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; and ‡Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

ABSTRACT
Mechanical circulatory support by a left ventricular assist device (LVAD) is used to bridge patients with advanced heart failure to transplant or as a definitive treatment. We retrospectively sought predictors of long-term outcome in a cohort of 83 patients who had undergone LVAD treatment. We subjected perioperative clinical data of patients to statistical analysis to establish parameters associated with all-cause mortality, and the cutoff values, sensitivity, and specificity of those that had a statistically significant relation with survival. Mean follow-up was 717 days (standard deviation, 334 days; range, 17-1,592 days). Fourteen patients (16.8%) died, but nine (10.8%) were weaned from support. Serum brain natriuretic peptide (BNP) concentration measured 60 days after implantation was significantly associated with all-cause mortality. The optimal BNP cutoff value to predict death during LVAD support was 322 pg/ml, with a sensitivity of 71.4% and specificity of 79.8%. Two-year survival was 92.0% in those with 60 days serum BNP concentration <322 pg/ml compared with 70.5% in those in whom it was ≥322 pg/ml (p = 0.003). The relation between BNP and survival likely reflects recovery of native myocardial function and improvements in global health and should assist clinicians in the on-going management of long-term LVAD therapy.

No MeSH data available.


Related in: MedlinePlus