Time‐Dependent Changes in B‐Type Natriuretic Peptide After Heart Transplantation: Correlation With Allograft Rejection and Function

Abstract

Endomyocardial biopsy is the gold standard to diagnose cardiac allograft rejection, although a noninvasive modality such as brain natriuretic peptide (BNP) is attractive. The authors examined the correlation of BNP levels with rejection patterns and allograft function in cardiac allograft recipients followed up to 8 years. One hundred forty-four consecutive patients underwent endomyocardial biopsy, right heart catheterization, and blood sampling. BNP levels decreased during the first 6 months after transplant but then reached a plateau. Time-dependent correlations were made between BNP levels and allograft rejection, left ventricular ejection fraction, pulmonary capillary wedge pressure, right atrial pressure, and serum creatinine. BNP levels were not different between patients with any rejection pattern and no rejection prior to or after 6 months following transplant. BNP levels did not correlate with ejection fraction, pulmonary capillary wedge pressure, right atrial pressure, or creatinine in the first 6 months after transplant. Statistically significant correlations existed between BNP and these parameters after 6 months following transplant. In cardiac transplant recipients, BNP levels decrease in the first 6 months following transplant and then reach a plateau regardless of the presence, type, or severity of allograft rejection. BNP levels do predict allograft rejection but correlate with allograft function after 6 months following transplant.

Repeated Measurements of NT-pro-B-Type Natriuretic Peptide, Troponin T or C-Reactive Protein Do Not Predict Future Allograft Rejection in Heart Transplant Recipients

“…However, most of these studies have focused on diagnostic and not prognostic value, and have used only the single measurements concomitant to the rejection episodes in their analyses. 12,[24][25][26][27] These studies have rendered inconsistent results. Few studies have examined prognostic value of repeated measurements of NT-proBNP or BNP for AR.…”

“…14,15 Other studies have found that despite the general decline in NT-proBNP levels after HTx, periodic increase in levels may also be present. 12,16,17 It has been suggested that abnormal renal function 12 and high pulmonary capillary wedge pressures 17 may contribute to this increase. On the other hand, a large study of Bader et al 12 suggested that a role for these clinical variables is less likely in the first 6 months after HTx.…”

“…12,16,17 It has been suggested that abnormal renal function 12 and high pulmonary capillary wedge pressures 17 may contribute to this increase. On the other hand, a large study of Bader et al 12 suggested that a role for these clinical variables is less likely in the first 6 months after HTx. A substantial decline after HTx has also been found for CRP, 9,18 troponin T, [19][20][21][22] and troponin I level 20 in previous studies.…”

“…9,12,13 Some studies have shown that plasma NT-proBNP levels do not normalize even years after HTx. 14,15 Other studies have found that despite the general decline in NT-proBNP levels after HTx, periodic increase in levels may also be present.…”

Changes in serial B-type natriuretic peptide level independently predict cardiac allograft rejection

“…These levels decreased thereafter, reaching a plateau by about 6 months post-transplantation. 16,17 To avoid this confounder in our analysis, we only included patients who underwent endomyocardial biopsies at Ն180 days post-transplant. All BNP measurements in this study were obtained from blood specimens collected at the time of endomyocardial biopsy procedure.…”