Abstract 2582: Combined Analysis of N-Terminal Prohormone Brain Natriuretic Peptide and C-Reactive Protein Improves their Predictive Value for Development of Cardiac Allograft Vasculopathy and All-Cause Mortality but not Acute Cellular Rejection in Heart Transplant Recipients
NT-proBNP and CRP are useful in risk stratification of patients with congestive heart failure. They could also be markers of distinctly altered hormonal and immunological milieus in heart transplant (HTx) recipients, and we assessed their combined predictive value for acute rejection, cardiac allograft vasculopathy (CAV) and all-cause mortality.
METHODS: A total of 210 clinically stable HTx recipients (mean age 50.6±10.7 yrs) were studied with a median follow-up of 5.4 (range 0.2–14.1) yrs. Of this cohort, 91 patients were assessed for rejection with endomyocardial biopsies and serial plasma samples from HTx to one yr post-HTx. All other patients (≥1 yr since HTx) had plasma samples taken upon inclusion at an annual visit. The entire population was followed for CAV (by yearly coronary angiography) and all-cause mortality.
RESULTS: In total, 1078 biopsies were performed and NT-proBNP and CRP levels were not significantly higher at times of acute rejection. When using all 210 patients’ annual visit sample, median NT-proBNP and CRP were 45.6 pmol/L and 1.41 mg/L, respectively. In total, 78 (37%) patients developed CAV and 39 (19%) patients died. In Cox analysis, neither NT-proBNP nor CRP were found to be predictors of CAV, but both were identified as predictors of all-cause mortality (HR 2.44, p=0.02; and 2.03, p=0.01, respectively). The combination of high NT-proBNP and CRP was found to be an independent predictor of CAV (HR 2.03, p=0.01) and all-cause mortality (HR 3.15, p<0.01).
CONCLUSION: NT-proBNP and CRP are not useful as markers of acute rejection, but combined analysis adds significantly to their predictive value for development of CAV and all-cause mortality in HTx recipients.