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ASAIO CARDIAC ABSTRACT

NEUROHUMORAL AND IMMUNE MARKERS AS PREDICTORS OF ACUTE DETERIORATION IN PATIENTS WITH END STAGE HEART FAILURE REQUIRING VENTRICULAR ASSIST DEVICE OR HEART TRANSPLANTATION

Potapov, E V1; Hennig, F1; Wagner, F D1; Volk, H D2; Ignatcnko, S1; Lehmkuhl, H H1; Hetzer, R1

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Background The optimal time point for HTx or VAD implantation in patients with congestive heart failure (CHF) remains controversial. Methods 67 patients with CHF requiring inotrops wee included into study. The patients were divided into two groups: Group I patients deteriorated into cardiogenic shock (CS, n=26) requiring emergency VAD placement; Group II patients presented stable clinical course, which allowed HTx or urgent VAD placement (n = 41). BNP and E-selectin were measured at the end of the study. Results There were no differences in clinical parameters between the groups. One day before CS occurred the area under the ROC curves for BNP was 0.69±0.7 and for E-selectin 0.77±0.07 (p=0.016 and 0.001 respectively). No correlation between BNP and E-selectin occurred (r=-0.02, p=0.88). The odds ratio (OR) for E-selectin using a cut-off point of 60 ng/ml was 6 one day before clinical deterioration (95% Cl 1.35–26.7, p= 0.02) and for BNP using cut-off of 500 pg/ml it was 4.8 (95% CI 1.5–15.3, p=0.008). After both parameters were combined using the above cut-off points, the OR increased to 11.9 (95% CI 3.2–44.3, p=0.003), if one or both parameters were above the cut-off. Conclusion While routine parameters did not predict clinical course, elevated BNP and E-selectin independently predicted CS 1 day before its occurrence. The combination showed increased predictive value. Daily measurement of these markers may be used to determine optimal time-point for HTx or VAD implantation.

Copyright © 2004 by the American Society for Artificial Internal Organs