The natriuretic peptide time-course in end-stage heart failure patients supported by left ventricular assist device implant: Focus on NT-proCNP

• Published in: Peptides (New York, N.Y. : 1980) Vol. 36; no. 2; pp. 192 - 198
• Main Authors: Cabiati, M., Caruso, R., Caselli, C., Frigerio, M., Prescimone, T., Parodi, O., Giannessi, D., Del Ry, S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2012
• Subjects: blood; correlation; Female; Heart failure; Heart Failure - drug therapy; Heart-Assist Devices; hemodynamics; Humans; interleukin-6; Left ventricular assist device; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Natriuretic Peptide, C-Type - blood; natriuretic peptides; NT-proANP; NT-proBNP; NT-proCNP; patients; Peptide Fragments - blood; t-SOFA score; tumor necrosis factor-alpha; Left ventricular assist device; Heart failure; NT-proANP; NT-proCNP; NT-proBNP; t-SOFA score
• ISSN: 0196-9781; 1873-5169
• DOI: 10.1016/j.peptides.2012.05.018

► Ventricular assist devices (VAD) lead to a modification of the neurohormonal profile. ► To evaluate the effects of VAD on natriuretic peptides plasma levels. ► Nt-proCNP would be useful for identifying patients more likely to recover.
This study aimed to evaluate left ventricular assist device (LVAD) effects on natriuretic peptide (NP) prohormone plasma levels in end-stage heart failure (HF) patients, especially NT-proCNP, in order to better characterize the NP system during hemodynamic recovery by LVAD. HF patients (n=17, NYHA III-IV) undergoing LVAD were studied: 6 died of multi-organ failure syndrome (NS) and 11 survived (S). Total sequential organ failure assessment (t-SOFA) score and blood samples were obtained at admission (T1) and at 24, 72h and 1, 2, 4 weeks (T2–T6) after LVAD. In S, NT-proANP and NT-proCNP significantly increased at 24h after implantation, reaching a reduction to basal levels at 4 weeks following LVAD [NT-proANP: T1 vs. T2 p=0.017, NT-proCNP: T1 vs. T2 p=0.028, T1 vs. T3 p=0.043]. Elevated NT-proBNP plasma levels were observed at all times. In NS, NP plasma levels sustained higher with respect to S. No statistical variation was observed for NT-proCNP and NT-proANP in S and NS while NT-proBNP reached significant differences at T4 in NS. Considering S+NS, only NT-proCNP strongly correlated with t-SOFA score at T1 (rho=0.554, p=0.04) while subdividing patients NT-proCNP positively correlated in NS with t-SOFA score (rho=0.988, p=0.002) only at T4. In NS a correlation between NT-proCNP and NT-proBNP at T1 was observed (rho=−0.900, p=0.037). Both IL-6 and TNF-alpha sustained higher in NS patients than in S; in particular, statistical significance was observed for IL-6. The study of new peptides, such as NT-proCNP, would provide additional information for identifying patients who are more likely to recover.