Dynamics of NT-pro BNP in Children Receiving Left Ventricular Assist Devices and Its Prognostic Value in Decision Making for Listing to Transplant or Successfully Weaning

Background: The prognostic utility of B-type natriuretic peptide (BNP) in heart failure is well recognized. Transformation of absolute pro BNP values into zlog pro BNP values recently made various pediatric age groups comparable. Previous studies have demonstrated that BNP levels decrease after the implantation of a left ventricular assist device (LVAD). We aimed to investigate the predictive value of changes in BNP levels in pediatric recipients of pulsatile flow LVADs before listing for transplantation or before successful explantation.

Methods: NT-pro BNP levels were measured in baseline and follow-up plasma samples from 11 children who received a pulsatile-flow LVAD over the past 8 years. These children had heart failure due to various forms of cardiomyopathy. NT-pro BNP measurements were taken before LVAD implantation, during LVAD support, and at the time of hemodynamic reevaluation before potential LVAD explantation. Absolute NT-pro BNP values were transformed into zlog values and then correlated with clinical outcomes.

Results: Zlog pro-BNP levels uniformly decreased in all patients after LVAD implantation. The mean zlog pro-BNP values before and during LVAD support were 5.86 ± 1.15 and 3.19 ± 1.25, respectively. Notably, zlog pro-BNP values in patients who were successfully weaned from LVAD (n = 4) (zlog pro-BNP = 2.03 ± 0.65) were significantly different from those of patients who had to be transferred to transplantation (n = 7) during the decision-making process (zlog pro-BNP = 3.96 ± 0.96) (p < 0.02, Mann–Whitney U test). The reported values are presented as mean values with standard deviations (SD).

Conclusion: From these limited data can be derived, that LVAD recipients with any type of persistent cardiomyopathy will recover with the support of a pulsatile flow LVAD, although their zlog pro-BNP levels may not return to a normal range. Patients who develop zlog NT-pro BNP values within upper limit of normal within 2 months on LVAD support have a potential for successful explantation. Patients with zlog-pro BNP values clearly exceeding 3 have to be transferred to transplantation. These findings may guide the clinical decision for early listing for transplantation or for the chance of recovery.

Publication History

Article published online:
13 February 2024