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Changes in serial B-type natriuretic peptide level independently predict cardiac allograft rejection. | LitMetric

Changes in serial B-type natriuretic peptide level independently predict cardiac allograft rejection.

J Heart Lung Transplant

Department of Internal Medicine, VA Central Iowa Health Care System, Des Moines, Iowa, USA.

Published: July 2012

AI Article Synopsis

  • Changes in B-type natriuretic peptide (BNP) levels were studied in heart transplant recipients to identify links with acute allograft rejection.
  • The analysis involved 1,350 biopsy samples from 205 patients, revealing a significant median change in BNP levels for those experiencing Grade ≥ 3A rejection compared to those who did not.
  • The study concluded that changes in BNP levels could serve as an effective non-invasive predictor for cardiac allograft rejection, supporting its use in clinical monitoring.

Article Abstract

Background: Despite positive associations with rejection, the clinical value of B-type natriuretic peptide (BNP) monitoring in heart transplant recipients has not been established. We sought to determine the predictive value of changes in serial BNP level for identifying patients with acute allograft rejection.

Methods: BNP, hemodynamics and biopsies were obtained for 205 transplant recipients who underwent a total of 4,007 endomyocardial biopsy procedures. Samples analyzed were collected ≥ 180 days post-transplant, without evidence of rejection on the immediately preceding biopsy. Using a repeated-measures multivariate model, we assessed the association of change in BNP with Grade ≥ 3A (2R) rejection. We also determined predictive values of various cut-off thresholds of change in serial BNP levels to predict Grade ≥ 3A rejection.

Results: There were 47 episodes of Grade ≥ 3A rejection among the 1,350 samples analyzed. Median change in serial BNP (ΔBNP) for those with Grade ≥ 3A rejection was 20 pg/ml (IQR -26 to 169 pg/ml) and among those with Grade <3A rejection was -4 pg/ml (IQR -34 to 22 pg/ml, p = 0.003). On multivariate analysis, ΔBNP remained the most potent independent predictor of Grade ≥ 3A rejection (p = 0.001). ΔBNP >100 pg/ml predicted increased risk of Grade ≥ 3A rejection (OR = 5.3, p < 0.001) with high specificity (93.3%) and positive predictive value (13.0%) and excellent negative predictive value (97.3%).

Conclusions: Change in serial BNP level is an independent predictor of cardiac allograft rejection. With wide availability, rapid turnaround, low cost, favorable positive predictive value and excellent negative predictive value, serial BNP monitoring has several advantages for non-invasive monitoring of heart transplant recipients for acute cardiac allograft rejection.

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Source
http://dx.doi.org/10.1016/j.healun.2012.02.014DOI Listing

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