The Investigation of Endomyocardial Biopsy Results, Plasma pro-BNP Levels and Non-invasive Parameters for Diagnosing of Acute Rejection in Patients Who Undergo Cardiac Transplantation

Year 2021, , 11 - 17, 23.04.2021

Özgür Akkaya

https://doi.org/10.30565/medalanya.831555

Abstract

Aim: Heart failure is a disease with high mortality and morbidity, reducing the patient's quality of life. Each year 10% of heart failure patients progress to end-stage heart failure. Cardiac transplantation is the gold standard treatment method in these patients, however acute rejection is the most important factor affecting the success of this treatment. In this study, it was aimed to evaluate endomyocardial biopsy results, serum pro-BNP and non-invasive parameters in patients with acute rejection following cardiac transplantation.

Patients and Methods: Twenty patients who underwent cardiac transplantation in our center were included in the study. The patients were divided into two groups, namely acute rejection (n: 10) and without rejection (n: 10). Echocardiography, electrocardiography (ECG), endomyocardial biopsy results, serum reactive proteins (CRP), sedimentation rate and serum pro-BNP levels, were evaluated among the patients and compared between the groups.

Results: Endomyocardial biopsies obtained from patients with acute rejection revealed grade 1 rejection in 6 (60%) patients, grade 2 in 3 (30%) patients and grade 3 rejection in 1 (10%) patients. CRP and sedimentation rate were found to be similar between the groups (p> 0.05). High pro-BNP levels were found in patients with rejection (4843.20 ± 6690.10 pg / ml) when compared to the control group (496.30± 216.20 pg / ml) (p: 0.001). In addition, higher pro-BNP levels were detected with progressing of rejection grade (p: 0.03). The highest pro-BNP level was found in a patient with Grade-3 rejection (15211 pg / ml, p: 0.000).

Conclusion: Our results show that serum pro-BNP levels are associated with acute rejection. In addition, higher pro-BNP levels were found to be associated with advanced rejection levels.

Keywords

Cardiac transplant, acute rejection, endomyocardial biopsy, pro-BNP

Thanks

This article has been produced from the medical specialty thesis, which titled " The comparision between endomyocardial biopsy results and blood pro-bnp levels to diagnose acute rejection in patients who undergo cardiac transplantation" prepared for Cardiovascular Surgery of Akdeniz University Faculty of Medicine. (Thesis number: 421999)

Kalp Transplantasyonu Yapılan Hastalarda Akut Rejeksiyon Tanısında Endomiyokardiyal Biyopsi Sonuçları, Plazma pro-BNP Seviyeleri ve Non-invazif Parametrelerin Araştırılması

Abstract

Amaç: Kalp yetersizliği, mortalite ve morbiditesi yüksek olan hastanın yaşam kalitesini
düşüren bir hastalıktır. Kalp yetmezliği hastalarının her yıl %10'u son dönem
kalp yetmezliğine ilerlemektedir. Bu hastalarda kalp nakli altın standart tedavi yöntemidir.
Ancak nakil hastalarında akut rejeksiyon tedavinin başarısını etkileyen en
önemli faktördür. Bu çalışmada kalp nakli sonrası akut rejeksiyon olan hastalarda
endomiyokardial biyopsi sonuçları, serum pro-BNP ve non-invazif parametrelerin
değerlendirilmesi amaçlanmıştır.

Hastalar ve Yöntem: Merkezimizde kalp nakli yapılan 20 hasta çalışmaya dâhil
edil-erek, akut rejeksiyon gelişen (n:10) ve gelişmeyen (n:10) olarak iki gruba
ayrılmıştır. Hastalar arasında ekokardiyografi, elektrokardiyografi (EKG),
endomiyokardiyal bi-yopsi sonuçları, serum reaktif protein (CRP), sedim ve serum
pro-BNP seviyeleri değerlendirilmiş ve gruplar arasında karşılaştırılmıştır.

Bulgular: Akut rejeksiyon gelişen hastalardan alınan endomiyokardiyal biyopsilerde
6(%60) hastada grade 1, 3(%30) hastada grade 2, 1(%10) hastada grade 3 rejeksiyon
bulguları, CRP ve sedimantasyon oranı gruplar arasında benzer olarak saptanmıştır
(p>0.05). Rejeksiyon olan hastalarda (4843,20 ± 6690,10 pg / ml) kontrol
grubu ile karşılaştırıldığında (496,30 ± 216,20 pg / ml) yüksek pro-BNP seviyeleri
tespit edilmiştir (p:0,001). Bunun yanı sıra rejeksiyon grade ilerledikçe daha yüksek
pro-BNP seviyelerine ulaşılmıştır (p:0,03). Bu bağlamda grade-3 rejeksiyon olan
hastada en yüksek pro-BNP düzeyi bulgusu elde edilmiştir (15211 pg / ml, p:0,000).

Sonuç: Bulgularımız serum pro-BNP düzeylerinin akut rejeksiyon ile ilişkili
olduğunu göstermiştir. Ayrıca daha yüksek pro-BNP düzeyleri ile rejeksiyon
seviyeleri ilişkili olarak bulunmuştur

Keywords

Kalp nakli, akut rejeksiyon, endomiyokardiyal biyopsi, pro-BNP

References

• 1.Severino P, Mather PJ, Pucci M, D'Amato A, Mariani MV, Infusino F, et al. Advanced Heart Failure and End-Stage Heart Failure: Does a Difference Exist. Diagnostics (Basel). 2019;9(4):170. doi: 10.3390/diagnostics9040170. PMID: 31683887; PMCID: PMC6963179.
• 2.Friedrich EB, Böhm M. Management of end stage heart failure. Heart. 2007;93(5):626-31. doi: 10.1136/hrt.2006.098814. PMID: 17435073; PMCID: PMC1955535.
• 3.Bouwens E, van den Berg VJ, Akkerhuis KM, Baart SJ, Caliskan K, Brugts JJ, et al. Circulating Biomarkers of Cell Adhesion Predict Clinical Outcome in Patients with Chronic Heart Failure. J Clin Med. 2020;9(1):195. doi: 10.3390/jcm9010195. PMID: 31936828; PMCID: PMC7020068.
• 4.Wilson SR, Mudge GH Jr, Stewart GC, Givertz MM. Evaluation for a ventricular assist device: selecting the appropriate candidate. Circulation. 2009;119(16):2225-32. doi: 10.1161/CIRCULATIONAHA.109.850610. PMID: 19398678.
• 5.Mingo-Santos S, Moñivas-Palomero V, Garcia-Lunar I, Mitroi CD, Goirigolzarri-Artaza J, et al. Usefulness of Two-Dimensional Strain Parameters to Diagnose Acute Rejection after Heart Transplantation. J Am SocEchocardiogr. 2015;28(10):1149-56. doi: 10.1016/j.echo.2015.06.005. PMID: 26165446.
• 6.Mendes VN, Pereira TS, Matos VA. Diagnosis of Rejection by Analyzing Ventricular Late Potentials in Heart Transplant Patients. Arq Bras Cardiol. 2016;106(2):136-44. doi: 10.5935/abc.20160011. PMID: 26815311; PMCID: PMC4765012.
• 7.Ozturk TC, Unluer E, Denizbasi A, Guneysel O, Onur O. Can NT-proBNP be used as a criterion for heart failure hospitalization in emergency room? J Res Med Sci. 2011;16(12):1564-71. PMID: 22973364; PMCID: PMC3434897.
• 8.Stewart S, Winters GL, Fishbein MC, Tazelaar HD, Kobashigawa J, Abrams J, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24(11):1710-20. doi: 10.1016/j.healun.2005.03.019. PMID: 16297770.
• 9.Ciliberto GR, Anjos MC, Gronda E, Bonacina E, Danzi G, Colombo P, et al. Significance of pericardial effusion after heart transplantation. Am J Cardiol. 1995;76(4):297-300. doi: 10.1016/s0002-9149(99)80085-x. PMID: 7618628.
• 10.Ciliberto GR, Mascarello M, Gronda E, Bonacina E, Anjos MC, Danzi G, et al. Acute rejection after heart transplantation: noninvasive echocardiographic evaluation. J Am CollCardiol. 1994;23(5):1156-61. doi: 10.1016/0735-1097(94)90605-x. PMID: 8144783.
• 11.Lee JH, Yeom SY, Hwang HY, Choi JW, Cho HJ, Lee HY, et al. Twenty-Year Experience of Heart Transplantation: Early and Long-Term Results. Korean J ThoracCardiovasc Surg. 2016;49(4):242-9. doi: 10.5090/kjtcs.2016.49.4.242. PMID: 27525232; PMCID: PMC4981225.
• 12.Gölbaşı İ, Belgi A, Beyazid Ö. Kalptransplantasyonundaakutrejeksiyontanıvetedavisi. KalpTransplantasyoun. EditörÖmerBeyazid. AkdÜnivYayın No:86. 1. Edisyon 2003:319-330
• 13.Özbaran M, Yağdı T, Nalbantgil S, Hamulu A, Zoghi M, Deniz N. Kalptransplantasyonusonrasıerkenvegeçdönemkomplikasyonlar. Turk. Goğ. KalpCerr 2002;10(3):149-154
• 14.Hamon D, Taleski J, Vaseghi M, Shivkumar K, Boyle NG. Arrhythmias in the Heart Transplant Patient. ArrhythmElectrophysiol Rev. 2014;3(3):149-55. doi: 10.15420/aer.2014.3.3.149. PMID: 26835083; PMCID: PMC4711495.
• 15.Madias JE. QRS Voltage Changes in Heart Failure: A 3-Compartment Mechanistic Model and its Implications. Indian Pacing Electrophysiol J. 2010;10(10):464-73. PMID: 21151385; PMCID: PMC2974334.
• 16.Mendes VN, Pereira TS, Matos VA. Diagnosis of Rejection by Analyzing Ventricular Late Potentials in Heart Transplant Patients. Arq Bras Cardiol. 2016;106(2):136-44. doi: 10.5935/abc.20160011. PMID: 26815311; PMCID: PMC4765012.
• 17.Friedberg M. Echocardiographic Detection of Heart Transplant Graft Dysfunction: A New Twist on an Old Theme. CircCardiovasc Imaging. 2016; 9e005439. https://doi.org/10.1161/CIRCIMAGING.116.005439
• 18.Badano LP, Miglioranza MH, Edvardsen T, Colafranceschi AS, Muraru D, Bacal F, et al. Document reviewers. European Association of Cardiovascular Imaging/Cardiovascular Imaging Department of the Brazilian Society of Cardiology recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation.Eur Heart J Cardiovasc Imaging. 2015; 16:919–948. doi: 10.1093/ehjci/jev139.
• 19.Talha S, Charloux A, Enache I, Piquard F, Geny B. Mechanisms involved in increased plasma brain natriuretic peptide after heart transplantation. Cardiovasc Res. 2011;89(2):273-81. doi: 10.1093/cvr/cvq331. PMID: 20962105.
• 20.Avello N, Prieto B, Molina BD, Rodriguez-Lambert JL, Alvarez FV. Clinical utility of NT-proBNP levels in late heart transplantation patients. ClinChimActa. 2010 Feb;411(3-4):161-6. doi: 10.1016/j.cca.2009.10.021. PMID: 19895796.
• 21.Yin D, Huang J, Feng L, Feng GX, Hu SS. [Association between serum NT-proBNP/hs-CRP and acute rejection after heart transplantation]. ZhonghuaXinXue Guan Bing ZaZhi. 2009;37(2):145-8. Chinese. PMID: 19719993.
• 22.Cuppoletti A, Roig E, Pérez-Villa F, Marin JL, Orús J, Vallejos I, et al. Value of NT-proBNP determinations in the follow-up of heart transplantation. Transplant Proc. 2005;37(9):4033-5. doi: 10.1016/j.transproceed.2005.09.150. PMID: 16386619.