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Increasing NT-ProBNP Levels Are Associated With Heart Failure Hospitalizations In Patients With Continuous Flow Left Ventricular Assist Devices
The 20th Annual Scientific Meeting vs 95.5%), SctO2-rest (64.5% vs 62.7%) or SctO2-6 min (62.3 vs 61.3) did not significantly differ either with or without supplemental O2, respectively. During 6MW in HF patients, oxygen supplementation did not alter walk distances, baseline or post walk SpO2 or SctO2, nor modest exercise declines observed in SpO2 and SctO2. Discussion: This study shows the complexity of peripheral /cerebral oxygen delivery in HF patients. It also suggests that 6MW, even in symptomatic HF patients, may not approximate AT in most patients. Given concern that repetitive episodes of cerebral hypoxia may contribute to cognitive dysfunction, a better understanding of this physiology is needed. In addition, SctO2 monitoring continues to show the potential to investigate organ perfusion and provide non-invasive, economical HF monitoring and management of disease progression, co-morbidity and guide management.
081 Increasing NT-ProBNP Levels Are Associated With Heart Failure Hospitalizations In Patients With Continuous Flow Left Ventricular Assist Devices Tania Vora, Ahmed Sara, Farooq H. Sheikh, Samer S. Najjar, David T. Majure; MedStar Washington Hospital Center, Washington, DC Background: Natriuretic peptides (NP) are both diagnostic and prognostic markers in patients with heart failure. Following LVAD implant, NP levels have been shown to decrease from pre-implant levels. Whether NP levels predict acute heart failure (AHF) hospitalizations post-LVAD implantation is unknown. Methods: All patients implanted with an LVAD between 1/2010 and 10/2015 were reviewed. Outpatient NT-ProBNP levels were collected. All hospitalizations for AHF post-LVAD implant were identified. We compared change in NT-ProBNP levels over time in patients who were and were not hospitalized for AHF using mixed effects linear regression model. Results: During the study, 278 patients received an LVAD. 201 patients had NTProBNP values available for analysis. Of these, 56 (33.5%) were hospitalized with AHF. An average of 15.7 ± 10.0 NT-ProBNP values were measured in the AHF group as compared to 14.4 ± 11.0 in those not hospitalized for AHF (P = .46). As compared to patients not hospitalized, AHF group patients were more often men (85.7% vs. 64.9%, P = .005), had higher BMI (29.6 ± 5.7 vs. 28.0 ± 6.4, P = .03) and were more often hypertensive pre-implant (78.6% vs. 58.6% P = .01). Average NTproBNP level of the AHF group was 3948 ± 4362 pmol/L (range 62.2–47704), while average level for non-AHF was 2279 ± 1903 pmol/L (range 32.6–22708) (P < .001). The slope of change in NT-ProBNP for the AHF group was 1.8 ± 1.8 pmol/L/day as compared to -2.1 ± 0.57 pmol/L/day for non AHF group (Figure). The change in NT-ProBNP was significantly different between the groups (P < .01). Conclusion: Patients hospitalized for AHF following LVAD had higher average NT-ProBNP levels and greater increases in NT-ProBNP levels over time than patients not hospitalized with AHF. Whether biomarker guided therapy could attenuate frequency of AHF hospitalizations should be further explored.
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HFSA
S31
082 Plasma Renin Activity in Distinct Patient Populations with Heart Failure and Reduced Ejection Fraction Petra Nijst1, Frederik H. Verbrugge1, Pieter Martens1, Philippe B. Bertrand1, Matthias Dupont1, Gary S. Francis2, W.H. Wilson Tang3, Wilfried Mullens1; 1Ziekenhuis Oost Limburg/ UHasselt, Genk, Belgium; 2University of Minnesota Health Heart Care, Minneapolis, MN; 3Cleveland Clinic, Cleveland, OH Background: Renin-angiotensin-aldosterone system (RAAS) activation in heart failure with reduced ejection fraction (HFREF) is detrimental through cardiac remodeling and water/salt retention. Aims: This study aims to describe RAAS activity in distinct HFREF populations—acute decompensation, chronic HFREF and HFREF with normalized ejection fraction after cardiac resynchronization therapy (CRT)—and to assess its prognostic impact. Methods and Results: In 72 acute decompensated HFREF patients (ADHF), 78 chronic HFREF patients without clinical signs of congestion and 53 patients with HF with normalized ejection fraction (HFNEF), venous blood samples and hemodynamic parameters were obtained. Subjects were prospectively followed up to 30 months. Plasma renin activity (PRA) is significantly lower in ADHF (1.5 ng/ml/h [0.8;5.7]) compared to stable HFREF (7.6 ng/ml/h [2.2;18.1] and HFNEF patients (3.9 ng/ml/h [1.0;13.0]) (all P < .05) (Fig. 1). PRA was significantly associated with arterial blood pressure, renin-angiotensin system blocker dose, beta-blocker dose, and mineralocorticoid receptor antagonist use (all P < .05) but not with age, left ventricular ejection fraction, heart rate, loop diuretic dose, creatinine or NT-pro BNP (all P > .05). High PRA levels are associated with increased cardiovascular mortality or HF admission in acute ADHF, but not in stable HFREF or HFNEF (Fig. 2). Conclusion: PRA is significantly elevated in ambulatory chronic HFREF patients, even when ejection fraction has normalized after CRT which is associated with blood pressure and medication use. Yet, in contrast to ADHF where PRA levels predict cardiovascular mortality and rehospitalizations, PRA levels are not associated with outcome in chronic HFREF and HFNEF.
081 Increasing NT-ProBNP Levels Are Associated With Heart Failure Hospitalizations In Patients With Continuous Flow Left Ventricular Assist Devices Tania Vora, Ahmed Sara, Farooq H. Sheikh, Samer S. Najjar, David T. Majure; MedStar Washington Hospital Center, Washington, DC Background: Natriuretic peptides (NP) are both diagnostic and prognostic markers in patients with heart failure. Following LVAD implant, NP levels have been shown to decrease from pre-implant levels. Whether NP levels predict acute heart failure (AHF) hospitalizations post-LVAD implantation is unknown. Methods: All patients implanted with an LVAD between 1/2010 and 10/2015 were reviewed. Outpatient NT-ProBNP levels were collected. All hospitalizations for AHF post-LVAD implant were identified. We compared change in NT-ProBNP levels over time in patients who were and were not hospitalized for AHF using mixed effects linear regression model. Results: During the study, 278 patients received an LVAD. 201 patients had NTProBNP values available for analysis. Of these, 56 (33.5%) were hospitalized with AHF. An average of 15.7 ± 10.0 NT-ProBNP values were measured in the AHF group as compared to 14.4 ± 11.0 in those not hospitalized for AHF (P = .46). As compared to patients not hospitalized, AHF group patients were more often men (85.7% vs. 64.9%, P = .005), had higher BMI (29.6 ± 5.7 vs. 28.0 ± 6.4, P = .03) and were more often hypertensive pre-implant (78.6% vs. 58.6% P = .01). Average NTproBNP level of the AHF group was 3948 ± 4362 pmol/L (range 62.2–47704), while average level for non-AHF was 2279 ± 1903 pmol/L (range 32.6–22708) (P < .001). The slope of change in NT-ProBNP for the AHF group was 1.8 ± 1.8 pmol/L/day as compared to -2.1 ± 0.57 pmol/L/day for non AHF group (Figure). The change in NT-ProBNP was significantly different between the groups (P < .01). Conclusion: Patients hospitalized for AHF following LVAD had higher average NT-ProBNP levels and greater increases in NT-ProBNP levels over time than patients not hospitalized with AHF. Whether biomarker guided therapy could attenuate frequency of AHF hospitalizations should be further explored.
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HFSA
S31
082 Plasma Renin Activity in Distinct Patient Populations with Heart Failure and Reduced Ejection Fraction Petra Nijst1, Frederik H. Verbrugge1, Pieter Martens1, Philippe B. Bertrand1, Matthias Dupont1, Gary S. Francis2, W.H. Wilson Tang3, Wilfried Mullens1; 1Ziekenhuis Oost Limburg/ UHasselt, Genk, Belgium; 2University of Minnesota Health Heart Care, Minneapolis, MN; 3Cleveland Clinic, Cleveland, OH Background: Renin-angiotensin-aldosterone system (RAAS) activation in heart failure with reduced ejection fraction (HFREF) is detrimental through cardiac remodeling and water/salt retention. Aims: This study aims to describe RAAS activity in distinct HFREF populations—acute decompensation, chronic HFREF and HFREF with normalized ejection fraction after cardiac resynchronization therapy (CRT)—and to assess its prognostic impact. Methods and Results: In 72 acute decompensated HFREF patients (ADHF), 78 chronic HFREF patients without clinical signs of congestion and 53 patients with HF with normalized ejection fraction (HFNEF), venous blood samples and hemodynamic parameters were obtained. Subjects were prospectively followed up to 30 months. Plasma renin activity (PRA) is significantly lower in ADHF (1.5 ng/ml/h [0.8;5.7]) compared to stable HFREF (7.6 ng/ml/h [2.2;18.1] and HFNEF patients (3.9 ng/ml/h [1.0;13.0]) (all P < .05) (Fig. 1). PRA was significantly associated with arterial blood pressure, renin-angiotensin system blocker dose, beta-blocker dose, and mineralocorticoid receptor antagonist use (all P < .05) but not with age, left ventricular ejection fraction, heart rate, loop diuretic dose, creatinine or NT-pro BNP (all P > .05). High PRA levels are associated with increased cardiovascular mortality or HF admission in acute ADHF, but not in stable HFREF or HFNEF (Fig. 2). Conclusion: PRA is significantly elevated in ambulatory chronic HFREF patients, even when ejection fraction has normalized after CRT which is associated with blood pressure and medication use. Yet, in contrast to ADHF where PRA levels predict cardiovascular mortality and rehospitalizations, PRA levels are not associated with outcome in chronic HFREF and HFNEF.