Department of Internal Medicine, VA Central Iowa Health Care System, Des Moines, Iowa, USA.
J Heart Lung Transplant. 2012 Jul;31(7):708-14. doi: 10.1016/j.healun.2012.02.014. Epub 2012 Apr 12.
Despite positive associations with rejection, the clinical value of B-type natriuretic peptide (BNP) monitoring in heart transplant recipients has not been established. We sought to determine the predictive value of changes in serial BNP level for identifying patients with acute allograft rejection.
BNP, hemodynamics and biopsies were obtained for 205 transplant recipients who underwent a total of 4,007 endomyocardial biopsy procedures. Samples analyzed were collected ≥ 180 days post-transplant, without evidence of rejection on the immediately preceding biopsy. Using a repeated-measures multivariate model, we assessed the association of change in BNP with Grade ≥ 3A (2R) rejection. We also determined predictive values of various cut-off thresholds of change in serial BNP levels to predict Grade ≥ 3A rejection.
There were 47 episodes of Grade ≥ 3A rejection among the 1,350 samples analyzed. Median change in serial BNP (ΔBNP) for those with Grade ≥ 3A rejection was 20 pg/ml (IQR -26 to 169 pg/ml) and among those with Grade <3A rejection was -4 pg/ml (IQR -34 to 22 pg/ml, p = 0.003). On multivariate analysis, ΔBNP remained the most potent independent predictor of Grade ≥ 3A rejection (p = 0.001). ΔBNP >100 pg/ml predicted increased risk of Grade ≥ 3A rejection (OR = 5.3, p < 0.001) with high specificity (93.3%) and positive predictive value (13.0%) and excellent negative predictive value (97.3%).
Change in serial BNP level is an independent predictor of cardiac allograft rejection. With wide availability, rapid turnaround, low cost, favorable positive predictive value and excellent negative predictive value, serial BNP monitoring has several advantages for non-invasive monitoring of heart transplant recipients for acute cardiac allograft rejection.
尽管 B 型利钠肽（BNP）监测与排斥反应呈正相关，但尚未确定其在心脏移植受者中的临床价值。我们旨在确定 BNP 水平变化的预测价值，以识别发生急性移植物排斥反应的患者。
对 205 名接受了总共 4007 次心内膜心肌活检的移植受者进行了 BNP、血流动力学和活检检查。分析的样本采集时间均为移植后≥180 天，在前一次活检中没有排斥反应的证据。我们使用重复测量多变量模型评估了 BNP 变化与≥3A（2R）排斥反应的相关性。我们还确定了 BNP 水平变化的各种截断阈值预测发生≥3A 排斥反应的预测值。
在分析的 1350 个样本中，有 47 个样本发生了≥3A 排斥反应。发生≥3A 排斥反应的患者的 BNP 变化中位数（ΔBNP）为 20pg/ml（IQR -26 至 169pg/ml），而发生<3A 排斥反应的患者为-4pg/ml（IQR -34 至 22pg/ml，p=0.003）。在多变量分析中，ΔBNP 仍然是发生≥3A 排斥反应的最有力的独立预测因子（p=0.001）。ΔBNP>100pg/ml 预测发生≥3A 排斥反应的风险增加（OR=5.3，p<0.001），具有高特异性（93.3%）和阳性预测值（13.0%），以及出色的阴性预测值（97.3%）。
BNP 水平变化是心脏移植物排斥反应的独立预测因子。由于广泛可用性、快速周转、低成本、良好的阳性预测值和出色的阴性预测值，BNP 连续监测在心脏移植受者中用于急性心脏移植物排斥反应的非侵入性监测具有多项优势。
