Abstract 14043: Usefulness of DTI Parameters and NTproBNP to Detect Acute Rejection in Heart Transplantation

Abstract

Heart transplantation (HT) is characterized by high left ventricular filling pressures (LVFP) and restrictive pattern at the beginning and these parameters could evolve during the follow-up. Acute rejection (AR) is a major cause of mortality and non-invasive management is essential to avoid excessive endomyocardial biopsies (EB). DTI parameters and NTproBNP levels can be used to predict LVFP. The aim of this study was to determine their utility to predict AR.

Methods. A total of 231 blood tests and 142 EB were done in 21 HT patients since 2009. According to the ISHLT criteria, 107 EB had AR grade 0R (75.8%), 30 1R (21.2%), 4 2R (2.8%) and 1 3R (0.8%). DTI parameters were measured the same day of the EB.

Results. In an initial analysis, diastolic echo parameters improved in the first year after HT: E med 6.95±1.5 vs. 9.12±2 p=0.001, E lat 11.77±3.6 vs. 14.15±3.9 p=0.038, medial E/E’ 14.3±3.4 vs. 8.8±3 p=0.001, lateral E/E’ 8.6±2.9 vs. 5.7±2.1 p=0.001. NTproBNP levels also improves : 7301±9042 vs 584±455 p=0.003. Comparison of DTI velocities in HT by AR status is shown in the table below. A strong correlation between lateral E/E’ and biomarkers was found (figure). NTproBNP improved the area under the ROC Curve (AUC) for the prediction of AR when added to lateral E/E from 0.612 (p=0.05) to 0.733 (p=0.005). Conclusions. LVFP measured by DTI and NT proBNP levels are increased soon after HT and become normal during the first year of follow-up. To the date this is the first study that shows a strong correlation between them in HT patients with and without AR. Diastolic echo parameters and NTproBNP are useful to predict AR. Their monitoring could be easily performed and suitable in non-invasive assessment of HT.