Prognostic Study of NT-proBNP in Heart Failure Patients With Left Ventricular Assist Device Implantation

To investigate the dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac Troponin I (cTnI) after left ventricular assist device (LVAD) implantation in patients with end-stage heart failure (ESHF), and to evaluate their prognostic value in predicting major adverse cardiac events (MACE), as well as to analyze the correlation between NT-proBNP and pump speed.

A total of 78 ESHF patients implanted with the HeartCon LVAD between September 2020 and March 2025 were enrolled. Levels of NT-proBNP and cTnI were measured preoperatively and on postoperative days (POD) 1, 7, 30, 60, and 90. Patients were followed for MACE (death or rehospitalization for right heart failure) within 6 months. Receiver operating characteristic (ROC) analysis, Cox regression, and Kaplan-Meier (KM) survival curves were used to evaluate prognostic indicators. Spearman analysis was applied to assess the correlation between NT-proBNP and pump speed.

NT-proBNP showed a significant reduction from a preoperative level of 4336.51 pg/mL to 2916.03 pg/mL on postoperative Day 1 (p = 0.01) and continued to decline, reaching 869.50 pg/mL by Day 90, although it remained above the upper reference limit. Total bilirubin (TBIL) increased markedly on Day 1 (from 16.60 to 32.70 μmol/L, p < 0.001) but returned to normal by Day 30 (11.30 μmol/L). cTnI peaked on Day 1 (from 0.58 to 18.93 ng/mL, p < 0.001), decreased significantly by Day 7 (to 2.24 ng/mL, p < 0.001), and normalized by Day 30 (0.15 ng/mL). ROC analysis showed that NT-proBNP on POD7 predicted MACE with an AUC of 0.749 (p = 0.004). Cox regression indicated that patients with NT-proBNP ≥ 2983 pg/mL on POD7 had a 6.2-fold higher risk of MACE (HR = 6.163, p = 0.001). Spearman analysis revealed a positive correlation between NT-proBNP and pump speed in the MACE(+) group (r = 0.314, p = 0.011).

LVAD effectively unloaded the left ventricle, leading to a significant reduction in NT-proBNP. NT-proBNP on POD7 served as an independent predictor of MACE. Moreover, pump speed positively correlated with NT-proBNP levels. Our findings provided a clinical evidence base supporting the application of precision medicine in the management of ESHF patients with LVAD implantation.