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See Latest ArticlesUsefulness of serial monitoring of B-type natriuretic peptide for the detection of acute rejection after heart transplantation
The American Journal of Cardiology, 04/15/09
Garrido IP et al. – Serial monitoring of serum B-type natriuretic peptide (BNP), evaluated as percent change, may be a useful noninvasive tool in clinical management of rejection.
Methods- Study of whether BNP may detect acute rejection in asymptomatic pts after heart transplantation (HT)
- Review of 259 routine endomyocardial biopsy specimens from 50 consecutive pts after HT: 83% men; age 50 ± 15 yrs
- Serial BNP measurements at biopsy
- BNP evaluated as absolute level (pg/mL) and percent change from previous biopsy (BNP - BNP at previous biopsy)/BNP at previous biopsy] × 100)
- Rejection defined as grade ≥2R International Society of Heart and Lung Transplantation grading system
- BNP correlated independently with time after HT, pulmonary artery systolic pressure, creatinine, and age
- Asymptomatic rejection in 15 biopsy specimens (6%), for which absolute BNP (106 pg/mL; interquartile range [IQR] 67-495) did not differ from nonrejection biopsy specimens (92 pg/mL; IQR 49-230)
- BNP percent change showed a median of +60% (IQR -29 to +154%) in rejection vs -17% (IQR -47 to +19%) in nonrejection biopsy specimens
- On multivariable adjustment, BNP percent change a consistent predictor of rejection
- Receiver-operator characteristic analysis showed percent change of <+38% as an optimal cut-off point, with a negative predictive value of 97%
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