Background: N-terminal fragment of the brain natriuretic peptide (NT-proBNP) is a well-established biomarker in heart failure; however, its prognostic value in patients supported by left ventricular assist devices (LVAD) remains unclear.
Methods: We conducted a retrospective cohort study including patients implanted with an LVAD between 2008 and 2025 at 2 tertiary care centers. NT-proBNP levels were measured at 3 and 6 months postimplantation, and their relationships with invasive hemodynamic parameters and 1-year clinical outcomes were evaluated at each time point.
Results: A total of 128 patients were included. Whereas NT-proBNP measured at 3 months showed no significant correlation with any hemodynamic parameters, NT-proBNP at 6 months correlated with right atrial pressure (ρ = 0.46, p < 0.01), systolic pulmonary artery pressure (ρ = 0.39, p = 0.03), and pulmonary capillary wedge pressure (ρ = 0.39, p = 0.02). NT-proBNP measured at 3 months was not significantly associated with 1-year mortality, pump thrombosis, or right ventricular (RV) failure. Conversely, NT-proBNP at 6 months was independently associated with an increased risk of the composite end-point of mortality or pump thrombosis (adjusted hazard ratio 1.34 [1.07-1.62] per 500 pg/ml increase), and the composite end-point of mortality or RV failure (adjusted odds ratio 1.53 [1.17-2.01] per 500 pg/ml increase).
Conclusions: NT-proBNP measured at 6 months post-LVAD implantation is a significant predictor of adverse clinical and hemodynamic outcomes at 1 year, supporting its role in risk stratification. Prospective studies are warranted to validate these findings.
Keywords: BNP; LVAD; NT-proBNP; advanced heart failure; monitoring; outcomes.
© 2025 International Society for Heart and Lung Transplantation.