Prognostic relationship between two serial determinations of B-type natriuretic peptide and medium-long-term events in heart transplantation.
BACKGROUND
Persistent elevation of B-type natriuretic peptide (BNP) levels in the first year after transplant appears to be associated with an adverse prognosis. However, there are no data on the prognostic value of two serial determinations of BNP at the end of the first year after transplant in clinically stable patients.


OBJECTIVE
The purpose of this study was to analyze the association between the increase in two serial determinations of BNP at the end of the first year and the subsequent development of events in medium-long-term follow-up.


METHODS
An observational study was conducted in a consecutive series of 71 patients transplanted between January 1999 and January 2001. Patients who were "unstable" or had other conditions that could elevate BNP levels (rejection, elevated pulmonary pressures, renal dysfunction, depressed ventricular function or severe graft vascular disease) were also excluded. The final number of patients included was 51. BNP determinations were performed at 9 and 12 months post-transplant at the same time as biopsies. Three groups were formed depending on the relationship between the two determinations: Group 1 (20 patients), decrease >20%; Group 2 (16 patients), change <20%; and Group 3 (15 patients), increase >20%. The following were considered events: death; late rejection; and ventricular dysfunction associated or not with graft vascular disease.


RESULTS
The baseline clinical profile was similar in the three groups. There was a significant difference in the rate of events (Group 1, 10%; Group 2, 32%; Group 3, 53%; p < 0.017). Event-free survival was statistically different between the groups (p = 0.017), mainly because of the large difference between Groups 1 and 3 (p = 0.003). Thus, cumulative event-free survival at 3,000 days was 89.4% for Group 1, 68.3% for Group 2 and 48.2% for Group 3.


CONCLUSIONS
The increase between two serial determinations of BNP levels at the end of the first year post-transplant could identify a subgroup of patients with poor outcome.
Martínez-Dolz
Luis
L
Heart Failure and Transplant Unit, Department of Cardiology, University Hospital La Fe, Valencia, Spain. lmartinezd@meditex.es
Almenar
Luis
L
Hervás
Isabel
I
Moro
José
J
Agüero
Jaime
J
Sánchez-Lázaro
Ignacio
I
Mateo
Antonio
A
Salvador
Antonio
A
D000328:Adult; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors
D020097:Natriuretic Peptide, Brain