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Usefulness of biomarkers to predict prognosis after heart transplant
Raquel López-Vilella1, Julia Martínez Solé2, Sara Huélamo Montoro2
1Unidad de Insuficiencia Cardiaca y Trasplante, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Insights
Elevated biomarkers after heart transplant (HT) predict poor outcomes. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 24 hours post-HT are highly accurate in identifying patients at risk for mortality or graft failure.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomarker Research
Background:
- Heart transplantation (HT) imposes significant physiological stress, leading to measurable changes in analytical biomarkers.
- Monitoring these biomarkers is crucial for assessing patient recovery and potential complications post-transplant.
Purpose of the Study:
- To investigate if post-heart transplant biomarker levels can predict patient prognosis.
- To identify specific biomarkers that indicate a higher risk of mortality or severe primary graft failure (PGF).
Main Methods:
- A prospective longitudinal study of 149 heart transplant recipients.
- Biomarker levels (high-sensitivity troponin T, NT-proBNP, creatinine, lactic acid) were measured pre-HT and at multiple time points up to 96 hours post-HT.
- Primary outcome: composite of death and severe PGF.
Main Results:
- Biomarker levels, particularly NT-proBNP and troponin, remained elevated post-HT, stabilizing within 24-72 hours.
- All analyzed biomarkers were significantly associated with the composite outcome (death or severe PGF).
- NT-proBNP at 24 hours demonstrated the highest discriminatory power, with a level of 10,000 pg/mL showing 90% sensitivity and 80% specificity.
Conclusions:
- Elevated post-heart transplant biomarker levels are significantly linked to adverse outcomes, including mortality and severe PGF.
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) emerged as the most effective biomarker for risk stratification in heart transplant recipients.
Introduction And Objectives:
Heart transplant (HT) represents a major physiological stress, resulting in elevated levels of analytical biomarkers. This study aimed to determine whether changes in biomarker levels after HT can identify patients with a poor prognosis.
Methods:
A prospective longitudinal noninterventional study was conducted in 149 consecutive patients undergoing HT from July 2017 to July 2023. Biomarkers were assessed before HT and at 6, 24, 48, 72, and 96hours after HT. The biomarkers analyzed were high-sensitivity troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine, and lactic acid. The primary outcome was a composite of death and severe primary graft failure (PGF).
Results:
NT-proBNP and troponin levels remained highly elevated throughout the period and stabilized from the first 24hours post-HT. Lactate levels stabilized after the first 24hours, and creatinine from the second day onward. Exitus occurred in 23 (15%) of the patients, and severe PGF in 26 (17%). All biomarkers were significantly associated with the incidence of the combined event (P <.0001). Receiver operating characteristic curve analysis at 24hours showed significant areas under the curve (P=.0001). The greatest discriminatory power was observed for the NT-proBNP curve. A value of 10 000 pg/mL had a sensitivity of 90% and specificity of 80%.
Conclusions:
A significant elevation of post-HT analytical biomarkers was associated with mortality and/or severe PGF. Among the biomarkers analyzed, NT-proBNP was the most accurate in classifying patients.
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