NT-proBNP trend and echocardiographic predictors after heart transplantation

Abstract Background natriuretic peptides have a key role in diagnosis and prognostication of patients with heart failure (HF). The transplanted heart has a peculiar physiology, partially related to surgical procedure and immunosuppression regimen, but is still not fully understood. The behaviour of N-terminal pro-B-type natriuretic peptide (NT-proBNP) after heart transplantation (HTX) needs precise definition to confirm its possible usefulness also in this setting, Aim: to describe the trend of NT-proBNP after HTX, assessing its possible predictors among pre- and post-operative echocardiographic and clinical variables. Methods we retrospectively screened a population of HTX patients with available long term follow up and pre-surgical information. Each patient neeed to had available repeated NT-proBNP measurements at 10 different time points including 1 month, 3 months, 6 months and 1 year after HTX. We excluded patients with heart re-HTX, unavailable pre-HTX right heart catheterization (RHC) or NT-proBNP results, poor echocardiographic acoustic window, unavailable complete blood tests or echocardiographic examinations. Each subject underwent complete echocardiography, blood samples including anti-HLA antibodies quantification, endomyocardial biopses and coronary angiographies and according to international guidelines. Results in a population of 71 HTX patients, major reduction of NT-proBNP was described at month 3 after surgery, with further reduction at 6 months and 1 year after which it tended to remain stable (Figure 1). All assessment revealed preserved ejection fraction. None of the patients developed a clinically relevant rejetion or coronary artery disease over a mean follow up of 2116,0 [1263,0; 2692,0] days, i.e. almost 6 years after HTX. Among predictors of NT-proBNP values, at regression analysis, 1-year NT-proBNP values was related to pre-HTX pulmonary wedge pressure by right heart catheterization and ischemic etiology but also to post-HTX kidney function and early tricuspid regurgitation severity; long term NT-proBNP values were instead predicted by positive HLA antibodies, age at HTX and mitral and tricuspid regurgitation severity at 12 month after HTX (Table 1). Conclusions NT-proBNP has a peculiar release after HTX and, compared to general HF population, has a stronger relationship with heart valve diseases severity than with systolic or diastolic left ventricular function. release