Protein Biomarkers Predict Risk of Gastrointestinal Bleeding in Left Ventricular Assist Device Patients

• Published in: The Journal of heart and lung transplantation Vol. 41; no. 4; p. S59
• Main Authors: Cavallo, K., Kanwar, M., Diao, G., Sinha, S.S., Singh, R., Tang, D., Isseh, I., Brocious, J., Bagchi, P., Crandall, D., Farrar, D.J., Murali, S., Walenga, J., Lindenfeld, J., deFilippi, C., Shah, P.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2022.01.135

Recently, protein biomarkers such as N-terminal B-type natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) have been shown to predict risk for gastrointestinal bleeding (GIB) and stroke in atrial fibrillation. This study aims to assess the validity of these biomarkers in predicting the incidence of stroke or GIB in LVAD recipients. Prospective LVAD patients were enrolled into the PREVENtion of Heartmate II Pump Thrombosis through Clinical Management (PREVENT) at 24 sites across the U.S along with patients from Inova Heart and Vascular Institute and Allegheny Health Network from 2014-2019. NT-proBNP and GDF-15 were measured before LVAD. Time to first stroke or GIB within 6-months was analyzed in relationship to the median biomarker concentration. A total of 470 patients were included in the analysis. Patients had the following characteristics: median patient age 60 years (IQR: 52-67), 80% male, 20% female, 75% White, 20% Black, 30% diabetes mellitus and 34% atrial fibrillation. Most patients had non-ischemic cardiomyopathy (46%) and were INTERMACS profile 2-3 (67%). At 6-months, 99 patients had a GIB (21%) and 32 had a stroke (7%). The median NT-proBNP was 2,551pg/ml (1,396-5,386) and GDF-15 was 5,000pg/ml (2,917-8,442). When patients were separated by the median biomarker concentrations, no difference in the incidence of stroke was noted (p=0.8). Similarly, the incidence of GIB with higher NT-proBNP concentrations was not significant (p=0.16, Figure A). Higher GDF-15 concentrations were associated with a higher incidence of GIB (p=0.02, Figure B). Patients with elevated GDF-15 levels had an incidence of GIB of 23% compared to 15% in patients with lower concentrations. Elevated levels of GDF-15 predict risk of GIB following LVAD implant. These data highlight the ability of novel biomarkers to predict complications that could potentially guide the selection of antithrombotic therapy after LVAD placement.