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Donor B-type natriuretic peptide predicts early cardiac performance after heart transplantation
Anne Vorlat1, Viviane M Conraads, Philippe G Jorens
1Department of Cardiology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, Wilrijk, Belgium. anne.vorlat@uza.be
Insights
B-type natriuretic peptide (BNP) levels in heart donors can predict early post-transplant cardiac performance. Higher donor BNP levels correlate with poorer recipient cardiac output, aiding donor heart selection.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomarker Research
Background:
- Decision-making in heart donation relies heavily on subjective evaluations.
- Objective biomarkers are needed to assess donor heart viability.
- B-type natriuretic peptide (BNP) is a potential biomarker for cardiac function.
Purpose of the Study:
- To evaluate B-type natriuretic peptide (BNP) as a discriminator for early post-transplant cardiac performance in heart donors.
- To analyze the correlation between donor BNP levels and recipient cardiac output.
- To determine if donor BNP can improve donor heart selection processes.
Main Methods:
- Prospective blood sample collection from 94 brain-dead patients, with 56 undergoing heart donation.
- Measurement of B-type natriuretic peptide (BNP) in heart donors.
- Correlation analysis of donor BNP with invasively measured cardiac output and hemodynamic parameters in recipients post-transplantation.
Main Results:
- Donors ineligible for heart donation had significantly higher BNP levels (287 pg/ml) compared to eligible donors (65 pg/ml).
- Donor BNP was a significant independent predictor of recipient cardiac output (CO), alongside donor age.
- A donor BNP level >160 pg/ml demonstrated 89% accuracy in predicting poor recipient cardiac performance.
Conclusions:
- Donor BNP levels are associated with early cardiac performance in heart transplant recipients.
- BNP measurement in heart donors can serve as a valuable tool for assessing donor heart suitability.
- Integrating BNP assessment may enhance objective decision-making in heart donation programs.
Background:
Decision processes in heart donation remain difficult and are often based on subjective evaluation. We measured B-type natriuretic peptide (BNP) in heart donors and analyzed its value as a discriminator for early post-transplant cardiac performance.
Methods:
Blood samples were prospectively obtained in 94 brain-dead patients, among whom 56 were scheduled for heart donation. BNP values were not available prior to donor selection. BNP of heart donors was related to invasively measured cardiac output and hemodynamic parameters, early after transplantation.
Results:
BNP, expressed as median (interquartile range), was 65 (32 to 149) pg/ml in brain-dead donors scheduled for heart donation. BNP was higher (287 pg/ml, range 65 to 457; p = 0.0001) in donors considered ineligible for heart donation. In 45 heart recipients, cardiac output (CO) of 5.6 (4.8 to 6.2) liters/min was measured at Day 12 (10-15). In the univariate analysis, recipient CO correlated significantly with donor BNP (r = -0.34, p = 0.025). Stepwise multiple regression, including donor variables such as body mass index, age, BNP, norepinephrine dose, gender and total ischemic time, identified donor BNP and age as the best independent predictors of CO in recipients (p = 0.02 and p = 0.005, respectively, R(2) of the model = 0.27). Donor BNP of >160 pg/ml had 89% accuracy to predict poor cardiac performance in the recipient (cardiac index <2.2 liters/min/m(2)). High donor BNP was independently correlated with a longer hospital stay.
Conclusions:
Donor BNP was found to be related to cardiac performance, early after cardiac transplantation. BNP measurement in heart donors could become a useful tool in the evaluation of donor hearts.
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