Effects of Left Ventricular Assist Device Support on Biomarkers of Cardiovascular Stress, Fibrosis, Fluid Homeostasis, Inflammation, and Renal Injury | Journal Scan

Study Questions:

What is the impact of left ventricular assist device (LVAD) support on a panel of biomarkers?

Methods:

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.

Results:

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).

Conclusions:

The authors concluded that a biomarker profile in patients after LVAD placement improves, but nonetheless remains significantly abnormal.

Perspective:

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.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Cardiac Surgery and Heart Failure, Heart Failure and Cardiac Biomarkers, Mechanical Circulatory Support

Keywords: Heart-Assist Devices, Biological Markers, C-Reactive Protein, Galectin 3, Growth Differentiation Factor 15, Natriuretic Peptide, Brain, Plasma


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