Abstract 4144258: Clinical value of bioactive adrenomedullin and proenkephalin A in patients with left ventricular assist devices

Introduction: In an acute heart failure setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting acute kidney injury (AKI) while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. Research questions: This raises the question of whether they can serve as predictive indicators for risk assessment in patients receiving left ventricular assist device (LVAD) implantation. Aims: we aimed to study whether pre- and postoperative bio-ADM and penKid levels could predict clinical outcomes in LVAD patients. Methods: This observational study prospectively enrolled patients who were undergoing LVAD implantation. Routine laboratory, Plasma levels of PenKid and bio-ADM were assessed at five-time intervals, spanning from pre-induction of anesthesia to 48 hours postoperatively. clinical data and patient outcomes were recorded, with a particular emphasis on right heart failure (RHF) and AKI. Results: In 20 patients undergoing LVAD implantation, the bio-ADM levels increased and the penKid levels decreased significantly over time. Preoperative PenKid was a predictor of postoperative AKI (OR: 1.04, 95%-CI: 1.0-1.09; p =0.035). Bio-ADM was a predictor of postoperative RHF (OR: 1.10, 95%-CI: 1.01-1.20; p =0.025) and early mortality (OR: 1.02, 95%-CI: 1.0-1.03; p =0.039). In the ROC analysis bio-ADM as a predictor of post-LVAD RHF had an area under the curve (AUC) of 0.83. Adding bio-ADM to accepted clinical scores for post-LVAD RHF prediction (CRITT-Score and RV-Michigan score) the AUC reached 0.93. Preoperative bio-ADM was also a useful predictor of early mortality and added prognostic value to the HeartMateII risk score and EuroSCOREII reaching an AUC of 0.96. Conclusion: In the present study, the biomarkers penKid and bio-ADM correlated with clinically significant patient outcomes after LVAD implantation, such as AKI and RHF. Adding Bio-ADM to well-established risk scores increased the prognostic value in the prediction of RHF. Preoperative penKid is a helpful marker to predict post-LVAD AKI.