Abstract 2464: Increase in N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide after Eurotransplant Urgency Listing as a Measure for Predicting Outcome after Heart Transplantation
Background When candidates for heart transplantation (HTx) show high levels of N-terminal brain-type natriuretic peptide (NT-proBNP), the prognosis of the patients is poor. However, identification of these high-risk patients is a matter for discussion. We investigated increase of NT-proBNP after listing with Eurotransplant for urgent HTx as a measure to predict outcome after HTx.
Methods Plasma NT-proBNP was measured in 59 HTx candidates without mechanical circulatory support before and after urgency listing. Complications and mortality after HTx in relation to changes in plasma NT-proBNP levels before and after urgency listing were studied. Percentile increases of maximal NT-proBNP values after urgency listing were compared with values prior to urgency listing and defined as delta-max NT-proBNP.
Results Area under the receiver operating characteristic (ROC) curve of delta-max NT-proBNP predicting mortality was 0.67. When the cut-off value for delta-max NT-proBNP was determined as 20%, 16 patients were in the group of increase in max NT-proBNP after urgency listing (Group INC) and the rest were in Group NON (n=43). Thirty-day mortality rate after HTx in Group INC was 37.5 % compared to 14.0 % in Group NON. Actuarial survival in Group INC was significantly worse than in the total of 180 patients who underwent HTx between 2004 and 2006 (p < 0.05, log-rank test). Incidence of infection was significantly higher (p < 0.001, Fisher’s exact probability test) in Group INC (68.8 %) than in Group NON (16.3 %). Long-term mechanical respiratory support (longer than 4 days) was more frequent (p < 0.05) in Group INC (87.5%) than in Group NON (55.8 %).
Conclusions Patients with an increase of NT-proBNP of greater than 20% during urgency listing are at higher risk for post-HTx mortality and complications. VAD implantation may be a valid approach in these patients, but this needs to be addressed in future studies.