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Prognostic relationship between two serial determinations of B-type natriuretic peptide and medium-long-term events
Luis Martínez-Dolz1, Luis Almenar, Isabel Hervás
1Heart Failure and Transplant Unit, Department of Cardiology, University Hospital La Fe, Valencia, Spain. lmartinezd@meditex.es
Insights
Serial B-type natriuretic peptide (BNP) measurements after heart transplant can predict patient outcomes. An increasing BNP level in stable patients one year post-transplant indicates a higher risk of adverse events.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomarker Research
Background:
- Persistent elevation of B-type natriuretic peptide (BNP) post-transplant is linked to poor prognosis.
- Limited data exist on the prognostic value of serial BNP measurements in stable transplant recipients.
Purpose of the Study:
- To investigate the association between changes in serial BNP levels at one year post-transplant and medium-to-long-term outcomes.
- To identify if an increase in BNP predicts subsequent adverse events in stable heart transplant patients.
Main Methods:
- Observational study of 51 stable heart transplant recipients.
- BNP levels measured at 9 and 12 months post-transplant.
- Patients categorized into three groups based on BNP change: decrease >20%, change <20%, or increase >20%.
Main Results:
- A significant difference in event rates was observed across groups (10% vs. 32% vs. 53%).
- Event-free survival varied significantly between groups (p=0.017).
- Patients with >20% BNP increase had lower cumulative event-free survival (48.2% at 3,000 days).
Conclusions:
- Serial BNP measurements at one year post-transplant can identify stable patients at high risk for adverse outcomes.
- An increasing trend in BNP levels post-transplant is a potential indicator of poor prognosis.
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.
