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Brain natriuretic peptide predicts serious cardiac allograft rejection independent of hemodynamic measurements.
J Heart Lung Transplant. 2005 Jan; 24(1):52-7.JH

Abstract

BACKGROUND

Serum brain natriuretic peptide (BNP) has been reported to be elevated in heart transplant recipients with both cellular and vascular rejection. Whether BNP can be used to help predict the severity of rejection is not well established.

METHODS

We analyzed serial BNP measurements obtained during endomyocardial biopsy procedures in consecutive heart transplant patients occurring >45 days after transplantation. To eliminate potential confounding from prior rejection episodes, we included only observations in which the previous biopsy grade was 0 or 1A. Multivariable linear regression was performed examining the outcome of increasing seriousness of rejection, defined as grade 0 < 1A < 2 < 1B < 3A < vascular rejection. A univariable logistic regression model was performed using log-transformed BNP as a predictor of vascular rejection.

RESULTS

There were 77 patients, with 161 separate observations. Median time between transplantation and first assessment was 6.0 months (interquartile range, 2.1, 31.6). Using multivariable linear regression, 3 factors were significantly associated with biopsy score: pulmonary capillary wedge pressure (p < 0.0001), BNP (p = 0.003), and heart rate (p = 0.01). Even after other significant univariable predictors (including pulmonary capillary wedge pressure) were forced into the model, BNP remained a significant predictor of biopsy score (p = 0.02). Log BNP was a significant univariable predictor of vascular rejection, with an odds ratio of 12.55 (per 1 unit increase, 95% confidence interval 3.43-45.84; p = 0.0001) and a model c-statistic of 0.91.

CONCLUSIONS

BNP predicts new episodes of serious cardiac allograft rejection, particularly vascular rejection, independent of hemodynamic measurements, and may be a useful part of rejection surveillance.

Authors+Show Affiliations

Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15653379

Citation

Wu, Audrey H., et al. "Brain Natriuretic Peptide Predicts Serious Cardiac Allograft Rejection Independent of Hemodynamic Measurements." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 24, no. 1, 2005, pp. 52-7.
Wu AH, Johnson ML, Aaronson KD, et al. Brain natriuretic peptide predicts serious cardiac allograft rejection independent of hemodynamic measurements. J Heart Lung Transplant. 2005;24(1):52-7.
Wu, A. H., Johnson, M. L., Aaronson, K. D., Gordon, D., Dyke, D. B., & Koelling, T. M. (2005). Brain natriuretic peptide predicts serious cardiac allograft rejection independent of hemodynamic measurements. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 24(1), 52-7.
Wu AH, et al. Brain Natriuretic Peptide Predicts Serious Cardiac Allograft Rejection Independent of Hemodynamic Measurements. J Heart Lung Transplant. 2005;24(1):52-7. PubMed PMID: 15653379.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Brain natriuretic peptide predicts serious cardiac allograft rejection independent of hemodynamic measurements. AU - Wu,Audrey H, AU - Johnson,Monica L, AU - Aaronson,Keith D, AU - Gordon,David, AU - Dyke,David B S, AU - Koelling,Todd M, PY - 2003/08/26/received PY - 2003/10/03/revised PY - 2003/10/10/accepted PY - 2005/1/18/pubmed PY - 2005/12/31/medline PY - 2005/1/18/entrez SP - 52 EP - 7 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J Heart Lung Transplant VL - 24 IS - 1 N2 - BACKGROUND: Serum brain natriuretic peptide (BNP) has been reported to be elevated in heart transplant recipients with both cellular and vascular rejection. Whether BNP can be used to help predict the severity of rejection is not well established. METHODS: We analyzed serial BNP measurements obtained during endomyocardial biopsy procedures in consecutive heart transplant patients occurring >45 days after transplantation. To eliminate potential confounding from prior rejection episodes, we included only observations in which the previous biopsy grade was 0 or 1A. Multivariable linear regression was performed examining the outcome of increasing seriousness of rejection, defined as grade 0 < 1A < 2 < 1B < 3A < vascular rejection. A univariable logistic regression model was performed using log-transformed BNP as a predictor of vascular rejection. RESULTS: There were 77 patients, with 161 separate observations. Median time between transplantation and first assessment was 6.0 months (interquartile range, 2.1, 31.6). Using multivariable linear regression, 3 factors were significantly associated with biopsy score: pulmonary capillary wedge pressure (p < 0.0001), BNP (p = 0.003), and heart rate (p = 0.01). Even after other significant univariable predictors (including pulmonary capillary wedge pressure) were forced into the model, BNP remained a significant predictor of biopsy score (p = 0.02). Log BNP was a significant univariable predictor of vascular rejection, with an odds ratio of 12.55 (per 1 unit increase, 95% confidence interval 3.43-45.84; p = 0.0001) and a model c-statistic of 0.91. CONCLUSIONS: BNP predicts new episodes of serious cardiac allograft rejection, particularly vascular rejection, independent of hemodynamic measurements, and may be a useful part of rejection surveillance. SN - 1053-2498 UR - https://www.unboundmedicine.com/medline/citation/15653379/Brain_natriuretic_peptide_predicts_serious_cardiac_allograft_rejection_independent_of_hemodynamic_measurements_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053249803005357 DB - PRIME DP - Unbound Medicine ER -