Effect of pre-operative N-terminal-pro-brain natriuretie levels on survival after heart transplantation among dilated cardiomyopathy patients / 中华器官移植杂志

ABSTRACT

Objective To study the effect of possible factors pre-operativly on recipient survival after heart transplantation among the dilated cardiomyopathy (DCM) patients.Methods 394 DCM recipients went through heart transplantation from June 2004 to October 2017 in our center,and the pre-operative NT-proBNP levels and risk factors influencing the post-operational survival reported by ISHLT retrospectively were analyzed.Kaplan Meier method was used to calculate the 1-10 years survival rate of the DCM patients and analyze the clinical data of the recipients and the donors,and the ROC method was applied to find the cutoff point of every pre-operation event.The recipients were divided into two groups according to the cutoff point:＜4 000 ng/L group (n =296) and ≥4 000 ng/ L group (n=73).COX regression curve was used to decide the hazard ratio and the Kaplan Meier curve was drawn.The result was verified by Log-rank.Results The cutoff point of the preoperative NT-proBNP level was 4000 ng/L.By analyzing the NT-proBNP levels between 2 groups,the relationship between them and the survival rate was acknowledged and the NT-proBNP level ≥4 000 ng/L was a risk factor (P =0.029,Kaplan Meier method).In the recipients whose pulmonary arterial systolic pressure (PASP) was more than 40 mmHg,the survival rate between ＜4 000 ng/L group (n =190) and ≥4 000 ng/L group (n =58)] showed significant difference (P =0.027),and there was no significant difference in the recipients whose PASP was less than 40 mmHg (P＞0.05).Conclusion The 1-,3-,5-,7-,and 10-year survival rate in our patients was 97.2％,94.5％,91.9％,88.0％ and 83.1 ％ respectively,which shows advantage over other international reports.The pre-operative NT-proBNP level ≥ 4 000 ng/L is a risk factor in the DCM patients who have pulmonary hypertension,so determination and dynamic monitoring of the pre-operative NT-proBNP level may be beneficial to the survival of cardiac transplantation,especially among the patients who have higher PASP level.