Brain natriuretic peptide and right heart dysfunction after heart transplantation

Abstract

Heart transplantation (HT) should normalize cardiac endocrine function, but brain natriuretic peptide (BNP) levels remain elevated after HT, even in the absence of left ventricular hemodynamic disturbance or allograft rejection. Right ventricle (RV) abnormalities are common in HT recipients (HTx), as a result of engraftment process, tricuspid insufficiency, and/or repeated inflammation due to iterative endomyocardial biopsies. RV function follow-up is vital for patient management as RV dysfunction is a recognized cause of in-hospital death and is responsible for a worse prognosis. Interestingly, few and controversial data are available concerning the relationship between plasma BNP levels and RV functional impairment in HTx. This suggests that infra-clinical modifications, such as subtle immune system disorders or hypoxic conditions, might influence BNP expression. Nevertheless, due to other altered circulating molecular forms of BNP, a lack of specificity of BNP assays is described in heart failure patients. This phenomenon could exist in HT population and could explain elevated BNP plasmatic levels despite a normal RV function. In clinical practice, intra-individual change in BNP over time, rather than absolute BNP values, might be more helpful in detecting right cardiac dysfunction in HTx.

Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation

“…As acute rejection promotes cardiomyocyte necrosis and results in compromised cardiac mechanics, troponin and BNP have been evaluated as potential diagnostic tools for ACR [34,35]. There have been controversial results on these biomarkers in the field of heart transplantation [15,36]. Our study used an ultrasensitive assay for cardiac troponin I that detects 10 to 100 times lower levels than standard assays.…”

The Endocrine Function of the Heart: Physiology and Involvements of Natriuretic Peptides and Cyclic Nucleotide Phosphodiesterases in Heart Failure

“…This lack of specificity of BNP assay kits described in HF might partly explain the persistent high plasma levels of BNP in the heart transplant population despite a recovery in hemodynamic conditions [108]. Moreover, even if ESC and ACC/AHA guidelines confirm the clinical utility of serum BNP or NT-proBNP for establishing disease and prognostic in chronic and acute HF, biomarker-“guided” therapy has produced inconsistent results in randomized controlled trials for the purpose of reducing hospitalizations or mortality [109].…”

A predictive model for dilated cardiomyopathy with pulmonary hypertension

“… 23 , 24 Right cardiac pressure variations account for up to 30% of plasma BNP level changes, and therefore, the degree of BNP level changes could be relevant to the severity of PH‐DCM. 25 Moreover, the ESC/ERS Guidelines recommend the measurement of NT‐proBNP and BNP as part of a multi‐parametric assessment for prognosis and as a goal to evaluate treatment outcomes for patients with PAH, simultaneously providing thresholds to define low‐risk (NT‐proBNP < 300 ng/L, BNP < 50 ng/L), intermediate‐risk (NT‐proBNP 300–1400 ng/L, BNP 50–300 ng/L) and high‐risk patients (NT‐proBNP > 1400 ng/L, BNP > 300 ng/L). 5 , 24 Although both compounds can be elevated in almost any LHD, compared with NT‐proBNP, BNP appears to have a slightly better correlation with PH and is less affected by kidney function.…”