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Updated: Aug 25, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Vasoactive peptides during long-term follow-up of patients after cardiac transplantation
Wiebke Ch Kirchhoff1, Rainer Gradaus, Joerg Stypmann
1Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany.
Insights
Cardiac transplantation (HTx) improves cardiac output but does not immediately normalize atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels. BNP decreases within 2 months, while ANP shows minimal change, indicating factors beyond cardiac function influence peptide levels.
Area of Science:
- Cardiology
- Biochemistry
- Transplantation Medicine
Background:
- Vasoactive peptides like ANP and BNP are key indicators of heart failure severity and response to treatment.
- Cardiac transplantation (HTx) aims to restore normal cardiac hemodynamics.
- Post-HTx, normalization of ANP and BNP plasma levels is anticipated.
Purpose of the Study:
- To investigate the longitudinal changes in plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels after orthotopic cardiac transplantation (HTx).
- To assess the relationship between hemodynamic parameters and natriuretic peptide levels in the first year post-HTx.
Main Methods:
- A long-term follow-up study of 14 patients (12 male, 2 female) aged 24-64 years post-HTx.
- Radioimmunoassay (RIA) was used to measure ANP and BNP in central venous plasma at multiple intervals up to 1 year post-HTx.
- Hemodynamic parameters including right atrial pressure (RAP), cardiac output (CO), and pulmonary capillary wedge pressure (PCWP) were monitored.
Main Results:
- ANP levels decreased significantly within 2 months post-HTx and remained stable, while BNP levels showed a continuous decrease without reaching normal values within the follow-up year.
- The mean ANP:BNP ratio increased significantly from 3.23 to 8.01 during the follow-up period.
- Cardiac output (CO) improved significantly from 5.21 L/min to 5.9 L/min, while other measured pressures (RAP, RVP, RVEDP, PCWP) remained unchanged.
Conclusions:
- Orthotopic HTx does not lead to immediate normalization of ANP and BNP plasma levels, despite improved cardiac function.
- BNP reduction occurs within 2 months post-HTx, but ANP levels remain elevated, suggesting other regulatory factors.
- The significant increase in the ANP:BNP ratio highlights the complex interplay of factors influencing natriuretic peptide levels post-cardiac transplantation.
Background:
Vasoactive peptides are accepted indicators of the degree of heart failure and its progression or improvement following medical therapy. Normalization of cardiac hemodynamics by cardiac transplantation (HTx) may lead to normalization of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) plasma levels shortly after the procedure.
Methods:
Long-term follow-up was done for 14 consecutive patients, 12 men and 2 women, 49 years of age (range 24 to 64 years). ANP and BNP were measured by radioimmunoassay (RIA) in central venous plasma samples (before breakfast, at steady state) at the following intervals after HTx: 7 to 30 (1), 31 to 60 (2), 61 to 90 (3), 120 to 180 (4) and 210 to 365 (5) days.
Results:
During follow-up, ANP decreased significantly within 2 months after HTx and continued of this level, whereas BNP decreased continuously without reaching normal values. The mean ratio of ANP:BNP increased from 3.23 to 8.01 during follow-up. Whereas right atrial pressure (RAP), right ventricular pressure (RVP), right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) did not change during follow-up, cardiac output (CO) improved slightly, but significantly from 5.21 liters/min to 5.9 liters/min (p = 0.035).
Conclusions:
Normalization of left ventricular function after orthotopic HTx does not induce an early diminution of ANP and BNP plasma levels to normal concentrations. Although elevated ANP concentrations showed only minimal changes within 1 year, BNP decreased significantly as early as 2 months after HTx, without reaching normal values during the year of follow-up. Also, the ratio of ANP and BNP increased significantly from 3.23 to 8.01. These results demonstrate the contribution of other factors beyond cardiac function that determine the levels of these peptides.
