Prognostic Value of Natriuretic Peptides for All-Cause Mortality, Right Ventricular Failure, Major Adverse Events, and Myocardial Recovery in Advanced Heart Failure Patients Receiving a Left Ventricular Assist Device: A Systematic Review

Abstract

Aims: Major adverse event (MAE) rates during left ventricular assist device (LVAD) therapy in advanced heart failure (HF) patients are high, and impair quality of life and survival. Prediction and risk stratification of MAEs in order to improve patient selection and thereby outcome during LVAD therapy is therefore warranted. Circulating natriuretic peptides (NPs) are strong predictors of MAEs and mortality in chronic HF patients. However, whether NPs can identify patients who are at risk of MAEs and mortality or tend toward myocardial recovery after LVAD implantation is unclear. The aim of this systematic review is to analyze the prognostic value of circulating NP levels before LVAD implantation for all-cause mortality, MAEs and myocardial recovery after LVAD implantation.Methods and Results: Electronic databases were searched for studies analyzing circulating NP in adults with advanced HF before LVAD implantation in relation to mortality, MAEs, or myocardial recovery after LVAD implantation. Twenty-four studies published between 2008 and 2021 were included. Follow-up duration ranged from 48 hours to 5 years. Study sample size ranged from 14 to 15,138 patients. Natriuretic peptide levels were not predictive of all-cause mortality. However, NPs were predictive of right ventricular failure (RVF) and MAEs such as ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization. No relation between NPs and myocardial recovery was found.Conclusion: This systematic review found that NP levels before LVAD implantation are not predictive of all-cause mortality after LVAD implantation. Thus, NP levels may be of limited value in patient selection for LVAD therapy. However, NPs help in risk stratification of MAEs and may be used to identify patients who are at risk for RVF, ventricular arrhythmias, moderate or severe aortic regurgitation, and all-cause rehospitalization after LVAD implantation.

Soluble Suppression of Tumorigenicity‐2 Predicts Mortality and Right Heart Failure in Patients With a Left Ventricular Assist Device

“… 25 In a systematic review, Janssen et al concluded that natriuretic peptides before LVAD implantation are not predictive of all‐cause mortality. 28 On the other hand, Bellavia et al showed that higher preoperative levels of NT‐proBNP were associated with a higher risk of post‐LVAD right heart failure.…”

Soluble suppression of tumorigenicity-2 (sST2) predicts mortality and right heart failure in LVAD patients

“…The copyright holder for this preprint this version posted February 8, 2023. ; https://doi.org/10.1101/2023.02.06.23285564 doi: medRxiv preprint LVAD implantation are not predictive of all-cause mortality. (27) On the other hand, Bellavia et al showed that higher pre-operative levels of NT-proBNP were associated with a higher risk of post-LVAD RHF.…”

“…(24) In a systematic review, Janssen et al concluded that natriuretic peptides before LVAD implantation are not predictive of all-cause mortality. (27) On the other hand, Bellavia et al showed that higher pre-operative levels of NT-proBNP were associated with a higher risk of post-LVAD RHF.…”

Prediction, prevention, and management of right ventricular failure after left ventricular assist device implantation: A comprehensive review

“…There is a growing interest in biomarkers as predictors of RVF. Elevated BNP reflects stretch of myocardial fibers and has been correlated with higher RVF rates ( 58 ). Increased osteopontin (>260 ng/ml) is a marker for greater extracellular matrix turnover and identifies patients with an ongoing profibrotic process that may potentially involve the RV, with increased risk of RVF ( 59 ).…”