Biomarkers to Assess Right Heart Pressures in Recipients of a Heart Transplant: A Proof-of-Concept Study

Qi-Fang Huang, Sander Trenson, Zhen-Yu Zhang, Jan Van Keer, Lucas N. L. Van Aelst, Wen-Yi Yang, Esther Nkuipou-Kenfack, Lutgarde Thijs, Fang-Fei Wei, Blerim Mujaj, Agnieszka Ciarka, Walter Droogne, Johan Vanhaecke, Stefan Janssens, Johan Van Cleemput, Harald Mischak, Jan A. Staessen*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    3 Citations (Web of Science)

    Abstract

    Background: This proof-of-concept study investigated the feasibility of using biomarkers to monitor right heart pressures (RHP) in heart transplanted (HTx) patients.

    Methods: In 298 patients, we measured 7.6 years post-HTx mean pressures in the right atrium (mRAP) and pulmonary artery (mPAP) and capillaries (mPCWP) along with plasma high-sensitivity troponin T (hsTnT), a marker of cardiomyocyte injury, and the multidimensional urinary classifiers HF1 and HF2, mainly consisting of dysregulated collagen fragments.

    Results: In multivariable models, mRAP and mPAP increased with hsTnT (per 1-SD, +0.91 and +1.26 mm Hg; P < 0.0001) and with HF2 (+0.42 and +0.62 mm Hg; P ≤ 0.035), but not with HF1. mPCWP increased with hsTnT (+1.16 mm Hg; P < 0.0001), but not with HF1 or HF2. The adjusted odds ratios for having elevated RHP (mRAP, mPAP or mPCWP ≥10, ≥24, ≥17 mm Hg, respectively) were 1.99 for hsTnT and 1.56 for HF2 ( P ≤ 0.005). In detecting elevated RHPs, areas under the curve were similar for hsTnT and HF2 (0.63 vs 0.65; P = 0.66). Adding hsTnT continuous or per threshold or HF2 continuous to a basic model including all covariables did not increase diagnostic accuracy ( P ≥ 0.11), whereas adding HF2 per optimized threshold increased both the integrated discrimination (+1.92%; P = 0.023) and net reclassification (+30.3%; P = 0.010) improvement.

    Conclusions: Correlating RHPs with noninvasive biomarkers in HTx patients is feasible. However, further refinement and validation of such biomarkers is required before their clinical application can be considered.

    Original languageEnglish
    Article number346
    Number of pages10
    JournalTransplantation Direct
    Volume4
    Issue number5
    DOIs
    Publication statusPublished - 1 May 2018

    Keywords

    • VENTRICULAR FILLING PRESSURES
    • URINARY PROTEOME ANALYSIS
    • CORONARY-ARTERY-DISEASE
    • TROPONIN-T ASSAY
    • CARDIAC TRANSPLANTATION
    • PULMONARY-HYPERTENSION
    • GENERAL-POPULATION
    • PROGNOSTIC VALUE
    • ACUTE REJECTION
    • DYSFUNCTION

    Cite this