| Objective:To assess the correlation between Pre-operative N-terminal-pro-brain natriuretic levels and early survival rate among heart transplantion (HT) recipients in a single Chinese center. Method:284HT cases in Fuwai hospital, performed between April2005to November2012, were prospectively analyzed. Based on the Pre-operative NT-proBNP level,2 distinct recipient groups were identified as<5000pmol/L (N=237) and≥5000pmol/L (N=47). Using SPSS17.0, univariate analysis were performed to compare the baseline characteristics and mortality for recipients with different primary cardiac diseases and on extracorporeal membrane oxygenation (ECMO) support. Kaplan-Meier method was used for survival analysis. Results:284recipients underwent HT, and70.8%for cardiomyopathy,20.8%for coronary arterydisease,3.9%for valvular heart disease,2.6%for left ventricular noncompaction (LVNC)and1.8%for congenital heart disease. The group with pre-operative NT-proBNP≥5000pmol/L (N=47), has an average systolic pulmonary artery pressure (sPAP) of52.6±12.9mmHg, diastolic pulmonary artery pressure (dPAP) of27.2±8.1mmHg, and left ventricular ejection fraction (LVEF)of27.4±10.8%. The group with pre-operative NT-proBNP<5000pmol/L (N=237), has an average sPAP of48.5±15.3mmHg, dPAP of24.9±8.3mmHg and LVEF of28.3±10.7%. There was no significant difference between the two groups in sPAP, dPAP and LVEF (p>0.05).14.8%of recipients in NT-proBNP≥5000pmol/L group used ECMO support, ECMO-related morbidities is71.4%and1-year survival rate is91.3%;6.7%of recipients used ECMO support in the other group, ECMO-related morbidities is12.5%and1-year overall survival rate is96.9%. There is significant difference between the two groups in ECMO proportion, ECMO-related mortality rate and1-year survival rate (p<0.05). Conclusion:Recipients with pre-operative NT-proBNP≥5000pmol/L has higher peri-operative ECMO-related morbidities and1-year death rate. So selecting and evaluating HT recipients at appropriate time, coupled with effective deceasing pre-operation NT-proBNP level treatment, may improve heart transplant short-term survival rate. [Abstract]:Objective:To Evaluate the relationship between preoperative NT-proBNP and invasive hemodynamic parameter, compare the value of NT-proBNP and mPAP on predicting long-term survival of patients after HT surgery. Methods:From April2005to June2013, Fu Wai Hospital conducted364cases of HT,306cases were selected according to the inclusion and exclusion criteria,, the general condition of the patient before surgery is described. Using scatter plots, correlation analysis and hierarchical analysis, evalutate the relationship between preoperative NT-proBNP, invasive hemodynamic, renal function. Using ROC curve to evaluate the prediction capability of preoperative mPAP and NT-proBNP on mortality. Finally using Kaplan-Meier method, compare the statistical difference of mPAP preoperative NT-proBNP different survival curves. Results:Between Aprial2005to June2013, in the306selected cases Male258cases (83.2%), cardiacomyopathy patients259cases (83.5%), mean preoperative serum creatinine was91.5±25.6(41.0～177.0) umol/L, mean preoperative NT-proBNP was2755.5±1499.7(112～10186) pmol/L, mean preoperative bilirubin was31.2±18.5(4～108) umol/L. Mean pulmonary artery systolic pressure was51.4±16.9(14～82) mmHg, mean pulmonary artery diastolic pressure was25.8±10.2(1～49) mmHg, mean pulmonary artery mean pressure was35.0±11.8(8～59) mmHg, mean cardiac index (CI) was2.0±0.7(1～3.4) L/(min. m2).mean pulmonary vascular resistance was3.8±2.2(0.4～16.2) Wood Units. Preoperative serum NT-proBNP and invasive hemodynamic parameters systolic pulmonary artery pressure, pulmonary artery diastolic pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index was significant correlation (r=0.176, r=0.179, r=0.185, r=0.193, r=-2.13, P<0.01). NT-proBNP<3000pmol/L group and≥3000pmol/L group, systolic pulmonary artery pressure, pulmonary artery diastolic pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, cardiac index is statistically different (P<0.05). mPAP ROC area under the curve is0.561, preoperative NT-proBNP ROC area under the curve is0.730. Two areas under the ROC curves were significantly different (P≥0.05). According to the mPAP level, divided the patients into mPAP<30mmHg and30mmHg groups, average follow-up of3years, there is no significant difference between the mortality of the2groups (P≥0.05). Divide the patients into<3000pmol/L and≥3000pmol/L groups, in accordance of preoperative NT-proBNP Post operation, the1-year,3-year,5-year survival rates were100%vs.88.4%,97.4%vs.75.5%,97.4%vs.64.8%respectively. Conclusion:Patients with end-stage heart failure, NT-proBNP and invasive hemodynamic correlation can predict the patient’s hemodynamic status and cardiac function. NT-proBNP mean pulmonary artery pressure compared with patients after long-term survival for more sensitive forecast. Objective:To investigate the relationship between heart transplant patients early NT-proBNP levels after surgery and peri-operative and medium to long term survival of the patient. Methods:This investigation analyses309patient cases of Fuwai hospital, the data from3years follow-ups. First, using classic ROC curve to find the cut-off point of postoperative early NT-proBNP levels and preditctions of short and long term mortality according to the cut-off point, patients were divided into low NT-proBNP group and high Nt-proBNP group, baseline data were compared. Draw Kaplan-Meier survival curves of the two groups, using the Log-rank method to evaluate the mortality of the two groups, lastly, using COX regression analysis to determine the risk factors affecting peri-operative and medium, long-term mortality after heart transplant. Results:Low NT-proBNP group262(<3000pmol/L), the average discharge NT-proBNP level was1559pmol/L (287.8～3155.2pmol/L), male84.9%, mean preoperative creatinine level was91.2±22.2umol/L, high NT-proBNP group47(≥3000mol/L), and discharged an average of NT-proBNP level was3943.9pmol/L (3184.210493.7pmol/L). Two receptors age, sex, height, weight, preoperative creatinine, history of hypertension, Swan-Ganz catheter indicators echocardiographic parameters, donor age and cold ischemia time were not statistically significant (P≥0.05). High NT-proBNP group CAD vs. Cardiomyopathy is lower than the low Nt-proBNP group (8.9%vs.22.7%, P<0.05). High NT-proBNP group preoperative total bilirubin levels above the low NT-proBNP group (36.1±18.8umol/L vs.30.2±18.2umol/L, P<0.05), high NT-proBNP group, the low proportion of diabetes at low NT-proBNP group (8.2%vs.14.7%). Low discharge NT-proBNP serum creatinine levels were significantly lower than the high group NT-proBNP group (P<0.05). High NT-proBNP group with low NT-proBNP group1,3,5,7year survival rates were86.8%vs.98.7%,83.2%vs.97.0%,83.2%vs.94.2%,69.3%vs.90.3%. Univariate COX regression analysis showed that coronary heart disease/Cardiomyopathy is a major risk factor affecting post operation in hospital, post operation1year and medium long term cadiac failure deaths, HR value of2.437(95%CI,0.964-6.097, P<0.05). Post operative creatinine is also a risk factor in patients cardiac failure death, HR=1.004(95%CI,0.989-1.020). The risk of patient cardiac failure is4.749-6.566times higher if the patients has TNI≥50ng/ml one or two days after the operation, than patients with TNI<50ng/ml After adjusting the effect of pre-operative NT-proBNP level, the risk of medium long post-operative cardiac failure death of the group with high preoperative NT-proBNP is7.4times lower than the group with low preoperative NT-proBNP,(95%CI,3.053-18.000, P<0.05),. After eliminating other factors using multivariate COX regression model, it can be proved that postoperative NT-proBNP≥3000pmol/L, high serum creatinine levels CAD/Cardiomyopathy, TNI≥50ng/ml one or two days after the operation are the major risk factors for death of the patient population in this study. Conclusion:Post operative early NT-proBNP level is an important risk factor in the mortality of heart transplant patients immediate after operation, and medium long term, the effect of strengthen the follow-up of patients with high NT-proBNP level in order to improve mortality requires further investigation.
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