CLINICAL STUDY: HEART FAILURE
Decreased plasma concentration of brain natriuretic peptide as a potential indicator of cardiac recovery in patients supported by mechanical circulatory assist systems
Ralf Sodian, MD*,*,
Matthias Loebe, MD, PhD*  ,
Christoph Schmitt, MD*,
Evgenij V. Potapov, MD*,
Henryk Siniawski, MD*,
Johannes Müller, MD*,
Harald Hausmann, MD*,
Heinz R. Zurbruegg, MD*,
Yuguo Weng, MD, PhD* and
Roland Hetzer, MD, PhD*
* Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasUSA
Manuscript received April 4, 2001;
revised manuscript received August 21, 2001,
accepted August 31, 2001.
* Reprint requests and correspondence: Dr. Ralf Sodian, Department of Thoracic and Cardiovascular Surgery, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
sodian{at}dhzb.de
OBJECTIVES
We sought to investigate the relationship between the plasma concentration of brain natriuretic peptide (BNP), echocardiographic findings and the clinical outcome of patients supported with ventricular assist devices (VADs) to determine the role of BNP as a predictor for cardiac recovery.
BACKGROUND
Ventricular unloading in patients with end-stage heart failure supported by VADs may lead to myocardial recovery. The BNP is produced in the myocardium in response to chronic volume overload, but the effects on it of ventricular unloading by VADs are largely unknown.
METHODS
Twenty-one patients diagnosed with nonischemic cardiomyopathy and supported by VADs were evaluated for echocardiographic data and blood chemistry including BNP. They were divided into patients who died while on mechanical support (group I; n = 9), patients who were transplanted (group II; n = 8) and patients who were successfully weaned off the system and did not require transplantation (group III; n = 4).
RESULTS
Brain natriuretic peptide plasma concentrations decreased significantly after initiation of mechanical circulatory support (p = 0.017). Furthermore, the changes in BNP plasma concentrations showed a faster decrease to normal levels within the first week after implantation of the VAD in patients who were weaned off the system (group III) compared to patients in group I and group II.
CONCLUSIONS
This study shows that ventricular unloading with VADs decreases BNP plasma concentrations in patients who suffer from end-stage heart failure. Furthermore, we hypothesize that an early decrease of BNP plasma concentration may be indicative of recovery of ventricular function during mechanical circulatory support.
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Abbreviations and Acronyms
| | ANP | = atrial natriuretic peptide | | BNP | = brain natriuretic peptide | | BVAD | = biventricular assist device | | LVAD | = left ventricular assist device | | LVEF | = left ventricular ejection fraction | | NYHA | = New York Heart Association | | TEE | = transesophageal echocardiography | | VAD | = ventricular assist device |
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