Heart Failure Symptom Biology in Response to Ventricular Assist Device Implantation.
Christopher S Lee, James O Mudd, Karen S Lyons and 7 others
PMID 30489416WHAT IT FOUND
After LVAD implantation, early and subtle symptoms and depression changed closely with NTproBNP, while pain and wake disturbances changed closely with sST2.
Dyspnea improved without closely matching NTproBNP.
Key findings
01After LVAD implantation, changes in NTproBNP were closely associated with changes in early and subtle symptoms and with changes in depression, but not with dyspnea.
02Changes in sST2 were closely associated with changes in pain severity and wake disturbances, but not with anxiety.
03Changes in sTNFαR1 were not closely associated with changes in pain severity or wake disturbances, and no other symptom-biomarker pairs showed close association.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was not a randomised trial, so it cannot show that biomarker changes caused symptom changes or that LVAD implantation alone caused them. The study was done at one centre, and the sample was predominantly male and Caucasian, so the findings may not apply to all patients. People with major psychiatric illness or major cognitive impairment were excluded, so these results do not speak to those groups. Only 180 days after implantation were followed, so longer term symptom and biomarker patterns are unknown. There is no standard sample size method for this kind of growth modelling, and the authors note limited evidence in this field.
Declared interests
The supplied metadata lists NIH extramural research support. No author conflicts of interest are reported in the article text.
The easy way to misread this
Do not conclude that NTproBNP can be used to track dyspnea or that sST2 proves the cause of pain or wake disturbances. The study only tested parallel change over time in one advanced heart failure sample and cannot show cause.