Prognostic Relationship Between Two Serial Determinations of B-type Natriuretic Peptide and Medium–Long-term Events in Heart Transplantation
Received 21 October 2007; received in revised form 2 April 2008; accepted 21 April 2008. published online 03 June 2008.
Background
Persistent elevation of B-type natriuretic peptide (BNP) levels in the first year after transplant appears to be associated with an adverse prognosis. However, there are no data on the prognostic value of two serial determinations of BNP at the end of the first year after transplant in clinically stable patients.
Objectives
The purpose of this study was to analyze the association between the increase in two serial determinations of BNP at the end of the first year and the subsequent development of events in medium–long-term follow-up.
Methods
An observational study was conducted in a consecutive series of 71 patients transplanted between January 1999 and January 2001. Patients who were “unstable” or had other conditions that could elevate BNP levels (rejection, elevated pulmonary pressures, renal dysfunction, depressed ventricular function or severe graft vascular disease) were also excluded. The final number of patients included was 51. BNP determinations were performed at 9 and 12 months post-transplant at the same time as biopsies. Three groups were formed depending on the relationship between the two determinations: Group 1 (20 patients), decrease >20%; Group 2 (16 patients), change <20%; and Group 3 (15 patients), increase >20%. The following were considered events: death; late rejection; and ventricular dysfunction associated or not with graft vascular disease.
Results
The baseline clinical profile was similar in the three groups. There was a significant difference in the rate of events (Group 1, 10%; Group 2, 32%; Group 3, 53%; p < 0.017). Event-free survival was statistically different between the groups (p = 0.017), mainly because of the large difference between Groups 1 and 3 (p = 0.003). Thus, cumulative event-free survival at 3,000 days was 89.4% for Group 1, 68.3% for Group 2 and 48.2% for Group 3.
Conclusions
The increase between two serial determinations of BNP levels at the end of the first year post-transplant could identify a subgroup of patients with poor outcome.
aHeart Failure and Transplant Unit, Department of Cardiology, University Hospital La Fe, Valencia, Spain
bDepartment of Nuclear Medicine, University Hospital La Fe, Valencia, Spain
cFoundation for Investigation, University Hospital La Fe, Valencia, Spain.
Reprint requests: Luis Martínez Dolz, MD, Heart Failure and Transplant Unit, Department of Cardiology, University Hospital La Fe, Cavanilles 26-11, 46010 Valencia, Spain. Telephone: 00-34-96-386-2759. Fax: 00-34-96-197-3314.
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