Significance of raised natriuretic peptides after bicaval and standard cardiac transplantation

High levels of plasma atrial natriuretic peptide (ANP) and ventricular natriuretic peptide (BNP) have been identified after standard orthotopic cardiac transplantation. It has been postulated that the high ANP levels are a result of persistent secretion from the large residual atrial mass after transplantation. This study was undertaken to investigate the significance of raised ANP and BNP levels after standard and bicaval orthotopic heart transplantation.

Plasma ANP and BNP levels were measured in 40 ambulatory, randomly selected cardiac transplant patients (group A, n = 20 had bicaval transplantation; group B, n = 20 had standard transplantation) and 10 healthy volunteers (group C). Cardiac transplant patients underwent endomyocardial biopsy and hemodynamic evaluation.

Plasma levels of ANP and BNP were elevated in the transplant recipients in comparison with normal volunteers (p = 0.0001 and p < 0.0001, respectively). There was no significant difference in the ANP levels between group A and group B, whereas BNP levels were higher in group B compared with group A (p = 0.03). Linear regression analysis showed that a faster heart rate, high mean pulmonary artery pressure, high pulmonary capillary wedge pressure, and high transpulmonary gradient were associated with higher levels of BNP (p < 0.05). Lower mean systemic pressure was associated with higher levels of ANP (p < 0.05).

High levels of ANP and BNP are synthesized and secreted by the transplanted denervated human heart regardless of the surgical technique. The level of BNP correlates with ventricular performance and afterload. The bicaval technique seems to be associated with better left ventricular and right ventricular diastolic performance.