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Eur J Cardiothorac Surg 2005;27:899-905
© 2005 Elsevier Science NL

Natriuretic peptides and E-selectin as predictors of acute deterioration in patients with inotrope-dependent heart failure

^a Deutsches Herzzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
^b Charité, Humboldt University Berlin, Campus Mitte, Berlin, Germany

Received 27 December 2004; received in revised form 20 January 2005; accepted 21 January 2005.

^* Corresponding author. Tel.: +49 304 5932065; fax: +49 304 5932079. (E-mail: potapov{at}dhzb.de).

Objective: In patients with inotrope-dependent end-stage heart failure the timely application of the most suitable treatment, i.e. heart transplantation, implantation of a ventricular assist device or conservative treatment, is a key issue for therapeutic success. Methods: Seventy-six inotrope-dependent patients with end-stage heart failure were enrolled. Measurements of hemodynamics, routine laboratory parameters, and clinical examination were performed daily. Additionally, natriuretic peptides (BNP and NT-proBNP) and E-selectin were measured at the end of the study. The patients were retrospectively divided into groups with regard to the following end-points: Group I—deterioration into cardiogenic shock after an initially stable clinical course (n=26); Group II—stable clinical course without deterioration into cardiogenic (n=41); Group III—weaning from inotropic support (n=9). Results: One day before cardiogenic shock occurred, BNP, NT-proBNP and E-selectin were significantly elevated in group I compared with group II. A logistic regression model showed that only BNP and E-selectin were independent predictors of clinical deterioration on the following day. The odds ratio (OR) for E-selectin using a cut-off point of 65ng/ml was 8.7 and for BNP using a cut-off of 500pg/ml it was 4.8. In combination, the OR increased to 11.1. Continuous decrease of NT-proBNP predicted patients in whom weaning from inotropes was possible. Conclusions: While routine parameters did not predict the clinical course, elevated BNP and E-selectin independently predicted cardiogenic shock on admission and 1 day before its occurrence. The combination showed increased predictive value.

Key Words: BNP • NT-proBNP • E-selectin • Ventricular assist device • Heart transplantation • Cardiogenic shock • Heart failure

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