B-type Natriuretic Peptide (BNP) as a Predictive Marker after Heart Transplantation.
- Author:
Hong Ju SHIN
1
;
Meong Gun SONG
;
Hee Jung KIM
;
Suk Jung CHOO
;
Jae Joong KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine. mgsong@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Heart transplantation;
Rejection;
Natriuretic peptide
- MeSH:
Atrial Pressure;
Biopsy;
Chungcheongnam-do;
Heart Failure;
Heart Transplantation*;
Heart*;
Hemodynamics;
Humans;
Hypertrophy;
Hypertrophy, Left Ventricular;
Myocytes, Cardiac;
Natriuretic Peptide, Brain*;
Plasma;
Pulmonary Wedge Pressure;
Retrospective Studies;
Sensitivity and Specificity;
Tricuspid Valve Insufficiency
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2007;40(8):552-557
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: B-type natriuretic peptide (BNP) is a cardiac hormone that is primarily synthesized by the ventricular cardiac myocytes. Increased plasma BNP levels have been observed in patients suffering with congestive heart failure, ventricular hypertrophy and myocaridits and also during heart transplantation rejection. We investigated the serum BNP level as a predictive marker for rejection after heart transplantation. MATERIAL AND METHOD: To test the usefulness of measuring the BNP level in cardiac transplant patients, consecutive blood samplings for BNP, right ventricular endomyocardial biopsies, hemodynamic measurements and transthoracic echocardiogram were all done in 10 such patients between January 2004 and August 2005 at the Department of Thoracic and Cardiovascular Surgery in Asan Medical Center. Two groups were identified with using the median value: the low BNP group (n=28, BNP: < or =290 pg/mL) and the high BNP group (n=29, BNP: >290 pg/mL). We retrospectively analyzed rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy, the pulmonary capillary wedge pressure and the right atrial pressure between the 2 groups. RESULT: There were no differences in age, gender, rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy and the right atrial pressure between the 2 groups (p>0.05). However, a higher pulmonary capillary wedge pressure and a higher mean pulmonary atrial pressure were observed in the high BNP group (p<0.05). Further, BNP has linear correlation with the pulmonary capillary wedge pressure (r=0.590, p<0.001). Using the cut-off value of 620 pg/mL, the BNP predicted a high PCWP (>12 mmHg) with a sensitivity of 83.3% and a specificity of 91.1% (AUC: 0.900+/-0.045, p<0.001). CONCLUSION: The BNP level after heart transplantation does not show any significant correlation with rejection, yet it might be a predictive marker of ventricular diastolic dysfunction.
