Decreased plasma concentration of brain natriuretic peptide as a potentialindicator of cardiac recovery in patients supported by mechanical circulatory assist systems

OBJECTIVES We sought to investigate the relationship between the plasma con centration of brain natriuretic peptide (BNP), echocardiographic findings a nd the clinical outcome of patients supported with ventricular assist devic es (VADs) to determine the role of BNP as a predictor for cardiac recovery. BACKGROUND Ventricular unloading in patients with end-stage heart failure s upported by VADs may lead to myocardial recovery. The BNP is produced in th e myocardium in response to chronic volume overload, but the effects on it of ventricular unloading by VADs arc largely unknown. METHODS Twenty-one patients diagnosed with nonischemic cardiomyopathy and s upported by, VADs were evaluated for echocardiographic data and blood chemi stry including BNP, They were divided into patients who died while on mecha nical 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 significa ntly after initiation of mechanical circulatory support (p = 0.017). Furthe rmore, the changes in BNP plasma concentrations showed a faster decrease to normal levels within the first week after implantation of the VAD in patie nts who were weaned off the system (group III) compared to patients in grou p 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 fail ure. Furthermore, we hypothesize that an early decrease of BNP plasma conce ntration may be indicative of recovery of ventricular function during mecha nical circulatory support. (J Am Coll Cardiol 2001;38: 1942-9) (C) 2001 by the American College of Cardiology.