Inability of Serum Myocyte Death Markers to Predict Acute Cardiac Allograft Rejection1,2

Abstract

Acute cardiac rejection involves myocyte necrosis. Hence, markers of myocyte death may be useful in diagnosing rejection. Creatine kinase MB, MB isoforms, and troponins I and T were measured in 186 patients undergoing 365 endomyocardial biopsies. No differences were noted with rejection (rejectors vs. nonrejectors: CK=63.8 U/L and 86.6 U/L, P=0.0881; CK MB=2.04 ng/ml and 2.06 ng/ml, P=0.949; troponin T=0.134 ng/ml and 0.0881 ng/ml, P=0.374; troponin I=0.216 ng/ml and 0.707 ng/ml, P=0.357). The time course of troponins T and I levels in rejectors and nonrejectors do not differ with both groups having early elevations. Markers of myocyte death are inadequate predictors of acute rejection in cardiac allografts. The time course of troponins T and I suggests a possible role as prognostic indicators of outcome.

Neuroendocrine Profiling of Humans Receiving Cardiac Allografts

“…This is consistent with another study suggesting that elevated cTnT after transplantation is related to donor ischemic time and cardiocyte ischemic injury. 4 Due to the inflammatory response associated with allograft rejection, circulating CRP levels may be expected to be a biomarker for rejection. The present study did not show any significant elevation of CRP levels in samples taken from rejecting patients.…”

“…Some studies have found that plasma levels of BNP, cTnT, TNF-␣ and IL-6 correlate with the International Society of Heart and Lung Transplantation (ISHLT) rejection grading system for endomyocardial biopsy scores, whereas other studies found no such correlation. [1][2][3][4][5][6] Therefore, no general consensus has been reached regarding the interrelationships of these neurohumors or their relationship to rejection status in cardiac transplant patients.…”

High-Sensitivity Cardiac Troponin I Assay to Screen for Acute Rejection in Patients With Heart Transplant

“…The c-statistic was 0.82 and at the optimized cut point of 15 ng/L sensitivity was 94% and the NPV was 99%, both notably higher than previous reports with standard assays (11%-89% and 79%-96%, respectively). 7,10,11,13,27 …”

N-Terminal pro-Brain natriuretic peptide as a potential non-invasive marker of cardiac transplantation rejection

“…It is well established that cTnT plasma concentrations are increased during the ¢rst month posttransplantation in response to surgery-related trauma. 6,7 However, contradictory results have been reported with regard to a potential relationship between rejection and plasma concentration of cTnT as a marker of myocardial necrosis. Higher concentrations of cTnT have been found in blood taken from a central line in patients diagnosed with cardiac rejection, 8 providing useful information complementary to the EMB.…”