Determination of neprilysin molecular level,after left ventricular assist device implantation of end stage heart failure patients

INTRODUCTION:Neprilysin plasma levels tend to increase with neurohormonal activation seen in heart failure inducing degradation of natriuretic peptides which in turn increases fibrosis and decreases diuresis. After left ventricular assist device(LVAD) implantation norohumoral activation mostly declines. However neprilysin plasma level changes after LVAD implantation is not studied before and also there is lack of data on association with pre-LVAD elevated neprilysin levels and short term outcomes after implantation. PURPOSE:We aimed to evaluate changes in neprilysin plasma levels after LVAD implantation and association of short term advers events METHODS:Patient whom had LVAD implantation procedure between January 2017 and October 2017 prospectively included in the study. Plasma Neprilysin levels measured before and 3 months after operation. Patients monitorised for advers events including mortality, stroke, pump thrombosis, gastrointestinal bleeding and right ventricular failure in the 3 months. RESULTS:Totally 47 patients (40 were male, average age was 54±11years, BMI was 25,70±3,89 kg/m2) were included the study. 42.6%(20) of the patients had ischemic etiology. Neprilysin levels significantly decreased from 175,28pg/ml to 75,30 pg/ml 3 months after LVAD implantation(p:0,007) Seven patients who had died after LVAD implantation has elevated neprilysin levels but weren't the statistically significant cause of limited mortality event (1798,51 pg/ml, 371,59 pg/ml p=0,134). Neprilysin levels were unrelated with age, gender, body mass index, renal function and etiology of heart failure. A cut-off value of 431 pg/ml was found to be predictive of adverse events within 3 months after the implantation with 71% sensitivity and 77% specificity (EAA: 0,682; %95 CI:0.387-0.977; p=0.128). -Patients with LVAD complication in first three months had liminal higher neprilysin levels and statistically significance (p=0,05). CONCLUSION: Although neurohormonal system activation decreases after LVAD implantation, it never returns to normal. Those patients who had complications within 3 months after the operation still had high levels of neurohormonal activation. For this reason, it is recommended to continue optimal medical therapy in patients who still have high levels of neprilysin after LVAD implantation.