Effects of Left Ventricular Assist Device Support on Biomarkers of Cardiovascular Stress, Fibrosis, Fluid Homeostasis, Inflammation, and Renal Injury | Journal Scan
What is the impact of left ventricular assist device (LVAD) support on a panel of biomarkers?
The study cohort was comprised of 37 individuals who underwent LVAD implantation. Frozen plasma samples obtained from these patients before and a median of 136 days (interquartile range, 94-180 days) after implantation were used to determine amino-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3, ST2, copeptin, growth differentiation factor (GDF)-15, C-reactive protein (CRP), and neutrophil gelatinase associated lipocalin (NGAL) levels.
The median age of the study cohort was 68 years. The study authors found that LVAD therapy was associated with significant decreases in NT-proBNP (3093-2090 pg/ml; p = 0.02), ST2 (67.5-45.2 ng/ml, p < 0.01), galectin-3 (24.7-22.0 ng/ml; p = 0.04), GDF-15 (3232-2613 ng/L; p < 0.001), hs-CRP (22.4-11.9 mg/L; p = 0.01), and copeptin (103-94 pmol/L; p = 0.003), but not NGAL (132-135 ng/ml; p = 0.06). The absolute values, however, remained abnormal despite improvements over time. Also, the greatest reductions in biomarkers occurred in individuals with >25% decrease in NT-proBNP concentrations, but the study found that it reached statistical significance only in the case of galectin-3 (p = 0.01).
The authors concluded that a biomarker profile in patients after LVAD placement improves, but nonetheless remains significantly abnormal.
This is an important study because it suggests that biomarkers may be a useful tool to monitor improvement with LVADs. Larger studies are needed to determine whether: 1) this improvement in biomarkers is simply due to LV unloading or also due to use of neurohormonal blockers, and 2) biomarkers could be used to predict whether a patient is a candidate for LVAD explantation.
Keywords: Heart-Assist Devices, Biological Markers, C-Reactive Protein, Galectin 3, Growth Differentiation Factor 15, Natriuretic Peptide, Brain, Plasma
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