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Inability of serum myocyte death markers to predict acute cardiac allograft rejection
C W Wang1, S R Steinhubl, W J Castellani
1Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Markers of myocyte death, including cardiac troponins, are not effective predictors for diagnosing acute cardiac rejection in heart transplant patients. Their levels did not significantly differ between rejection and non-rejection groups.
Area of Science:
- Cardiology
- Transplantation Immunology
- Biomarker Research
Background:
- Acute cardiac rejection is a critical complication following heart transplantation.
- Myocyte necrosis occurs during acute cardiac rejection, suggesting myocyte death markers could be diagnostic.
- Creatine kinase (CK), CK-MB, troponin T, and troponin I are established markers of myocyte injury.
Purpose of the Study:
- To evaluate the utility of myocyte death markers (CK, CK-MB, troponin T, troponin I) in diagnosing acute cardiac rejection.
- To assess the diagnostic accuracy of these biomarkers in patients undergoing endomyocardial biopsies.
Main Methods:
- Prospective measurement of CK, CK-MB, troponin T, and troponin I levels.
- Analysis of biomarker levels in 186 patients undergoing 365 endomyocardial biopsies.
- Comparison of biomarker levels between patients with and without confirmed acute rejection.
Main Results:
- No significant differences were observed in CK, CK-MB, troponin T, or troponin I levels between rejectors and non-rejectors.
- Early elevations in troponin T and I levels were noted in both rejection and non-rejection groups.
- The time course of troponin T and I levels did not differentiate between rejection status.
Conclusions:
- Myocyte death markers are inadequate predictors for diagnosing acute cardiac rejection in heart allografts.
- The temporal patterns of troponin T and I may serve as potential prognostic indicators for patient outcomes.
Abstract:
Acute cardiac rejection involves myocyte necrosis. Hence, markers of myocyte death may be useful in diagnosing rejection. Creatine kinase MB, MB isoforms, and troponins I and T were measured in 186 patients undergoing 365 endomyocardial biopsies. No differences were noted with rejection (rejectors vs. nonrejectors: CK=63.8 U/L and 86.6 U/L, P=0.0881; CK MB=2.04 ng/ml and 2.06 ng/ml, P=0.949; troponin T=0.134 ng/ml and 0.0881 ng/ml, P=0.374; troponin I=0.216 ng/ml and 0.707 ng/ml, P=0.357). The time course of troponins T and I levels in rejectors and nonrejectors do not differ with both groups having early elevations. Markers of myocyte death are inadequate predictors of acute rejection in cardiac allografts. The time course of troponins T and I suggests a possible role as prognostic indicators of outcome.