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C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart
Débora Cestari Bacal1, Miguel Morita Fernandes-Silva2, Sandrigo Mangini1
1Programa de Transplante Cardiaco, Hospital Israelita Albert Einstein (HIAE), Sao Paulo, SP, BR.
Insights
C-reactive protein (CRP) and left ventricular (LV) mass index can help diagnose acute cellular rejection (ACR) after heart transplant (HT). These non-invasive biomarkers show promise in identifying ACR, potentially reducing the need for invasive procedures.
Area of Science:
- Cardiology
- Transplant Medicine
- Biomarker Discovery
Background:
- Acute cellular rejection (ACR) is a significant complication following heart transplant (HT).
- Endomyocardial biopsy (EMB) is the current standard for ACR diagnosis, but non-invasive biomarkers are needed.
- This study focuses on HT recipients with preserved left ventricular (LV) function.
Purpose of the Study:
- To identify non-invasive biomarkers for diagnosing ACR in heart transplant patients.
- To evaluate the predictive value of C-reactive protein (CRP) and LV mass index for ACR.
- To assess the diagnostic accuracy of these biomarkers.
Main Methods:
- Retrospective analysis of 72 heart transplant recipients between 2010 and 2019.
- Measurement of CRP, troponin, and B-type natriuretic peptide (BNP) levels prior to EMB.
- Logistic regression and ROC curve analysis to identify and evaluate ACR predictors.
Main Results:
- Nine patients (12.5%) developed ACR (ISHLT grade 2R or 3R).
- Elevated CRP levels (≥15.9 mg/L) and LV mass index (≥111 g/m²) were independent predictors of ACR.
- The combined model achieved an AUC of 0.87, with high sensitivity and specificity.
Conclusions:
- CRP level and LV mass index are significantly associated with ACR in heart transplant recipients.
- Troponin and BNP levels did not show a significant association with ACR.
- These non-invasive markers may aid in the early detection of ACR.
Objectives:
Acute cellular rejection (ACR) remains a major complication of heart transplant (HT). The gold standard for its diagnosis is endomyocardial biopsy (EMB), whereas the role of non-invasive biomarkers for detecting ACR is unclear. This study aimed to identify non-invasive biomarkers for the diagnosis of ACR in patients undergoing HT and presenting with normal left ventricular function.
Methods:
We evaluated patients who underwent HT at a single center between January 2010 and June 2019. Patients were enrolled after HT, and those with left ventricular (LV) systolic dysfunction before EMB were excluded. We included only the results of the first EMB performed at least 30 days after HT (median, 90 days). Troponin, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) levels were measured and echocardiography was performed up to 7 days before EMB. ACR was defined as International Society for Heart and Lung Transplantation grade 2R or 3R on EMB. We performed logistic regression analysis to identify the non-invasive predictors of ACR (2R or 3R) and evaluated the accuracy of each using area under the receiver operator characteristic curve analysis.
Results:
We analyzed 72 patients after HT (51.31±13.63 years; 25 [34.7%] women); of them, 9 (12.5%) developed ACR. Based on multivariate logistic regression analysis, we performed forward stepwise selection (entry criteria, p<0.05). The only independent predictors that remained in the model were CRP level and LV mass index. The optimal cut-off point for CRP level was ≥15.9 mg/L (odds ratio [OR], 11.7; p=0.007) and that for LV mass index was ≥111 g/m2 (OR, 13.6; p=0.003). The area under the receiver operating characteristic curve derived from this model was 0.87 (95% confidence interval [CI], 0.75-0.99), with sensitivity of 85.7% (95% CI, 42.1%-99.6%), specificity of 78.4% (95% CI, 64.7%-88.7%), positive predictive value of 35.3% (95% CI, 14.3%-61.7%), and negative predictive value of 97.6% (95% CI, 87.1%-99.9%).
Conclusions:
Among patients undergoing HT, CRP level and LV mass were directly associated with ACR, but troponin and BNP levels were not.
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