Effect of the implantable left ventricular assist device on neuroendocrine activation in heart failure

K. B. James*, P. M. McCarthy, J. D. Thomas, R. Vargo, R. E. Hobbs, S. Sapp, E. Bravo

*Corresponding author for this work

Research output: Contribution to journalArticle

143 Scopus citations

Abstract

Background: The HeartMate left ventricular assist device has been successfully used as a bridge to cardiac transplantation. Because many patients exhibit marked clinical improvement in their heart failure after HeartMate implantation, we studied the physiological effect of this device on the neurohormonal axis. Methods and Results: In 13 patients awaiting transplant (mean cardiac index. 1.7±0.3 L · min-1 · m-2) who underwent HeartMate implantation, venous atrial natriuretic peptide, epinephrine, norepinephrine, plasma renin activity, angiotensin, and arginine vasopressin were measured immediately before insertion and at explant/transplantation. Mean time to explant was 86±40 days. All patients were taken off inotropic medications within 1 month. Mean cardiac index on support before explant was 3.1±0.9 L · min-1 · m-2. Plasma renin activity decreased from 57±56 ng · mL-1 · h-1 at baseline (before insertion) to 3±3 ng · mL-1 · h-1 at explant (mean percent change, 92%; P<.001). Angiotensin II level decreased from 237±398 U/L at baseline to 14±14 U/L at explant (mean percent change, 73%; P<.001). Plasma epinephrine level fell from 6800±1323 pg/mL at baseline to 46±46 pg/mL at explant (mean percent change, 86%; P<.001). Norepinephrine level decreased from 2953±1457 pg/mL at baseline to 518±290 pg/mL at explant (mean percent change, 79%; p<.001). Atrial natriuretic peptide fell from baseline values of 227±196 to 168±40 pg/mL at explant (mean percent change, 49%; P=.519); and arginine vasopressin level decreased from 6±6 pg/mL at baseline to 0.8±0.5 pg/mL (mean percent change, 69%; P=.002). Conclusions: We provide data supporting that the neurohormonal axis markedly improves after HeartMate implantation, providing biochemical confirmation of the improvement in hemodynamic status.

Original languageEnglish (US)
Pages (from-to)II191-II195
JournalCirculation
Volume92
Issue number9 SUPPL.
StatePublished - Jan 1 1995

Keywords

  • cardiomyopathy
  • heart failure
  • heart-assist device
  • hormones

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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