Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Myocardial and inflammatory markers in cardiac allograft vasculopathy and coronary artery disease
L. Köster1, J. Weimann2, B. Bay1, C. M. Blaum1, L. Thies2, P. M. Clemmensen1, H. Reichenspurner3, P. Kirchhof1, T. Zeller1, M. Seiffert1, C. Waldeyer1, S. Blankenberg1, C. Magnussen1, F. J. Brunner1
1Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 2Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg; 3Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg;

Background: Cardiac allograft vasculopathy (CAV) is one of the major risk factors for graft failure after heart transplantation (HTX). The disease processes leading to CAV may be different compared to atherosclerotic coronary artery disease (CAD). To quantify three disease processes linked to atherosclerosis, we compared the association of high-sensitivity troponin T and I (hsTnT/I), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) with CAV in HTX patients and with CAD in a matched cohort of non-HTX patients.

Methods: Matched pair analysis was performed in patients undergoing coronary angiography after HTX and control subjects enrolled in the prospective INTERCATH cohort study. HTX recipients were matched for age, sex, arterial hypertension, body mass index (BMI), diabetes mellitus and severity of CAV and CAD with non-HTX patients in a 1:2 ratio. Severity of CAV and CAD was classified according to the coronary angiogram grading scale of the International Society for Heart and Lung Transplantation and the number of affected coronary vessels, respectively. Logistic regression for CAV and CAD, adjusted for age and sex, was performed with log-transformed hsTnT/I, NT-proBNP and hsCRP as independent variables. Results were presented as odds ratios (OR) per standard deviation (SD) and their 95 % confidence interval (CI).

Results: 60 patients after HTX and 120 matched controls were included in this analysis (median age 55.9 (IQR 48.1 - 64.7) years, 7.2 % women). Median time since HTX was 10.6 (IQR 9.1 - 12.2) years. 75 % of patients had no significant CAV/CAD whilst 15.0 %, 6.7 %, and 3.3 % suffered from CAV/CAD according to ISHLT grade 1-3/coronary 1-3 vessel disease. In HTX patients, hsTnI (OR 1.91; 95 % CI 0.97, 4.20), hsTnT (OR 3.63; 95 % CI 1.55, 11.51), and NT-proBNP (OR 2.89; 95 % CI 1.44, 6.93) were associated with CAV whilst hsCRP was not (OR 1.71; 95 % CI 0.94, 3.52). Of these biomarkers only hsTnT was associated with CAD (OR 1.59; 95 % CI 1.03, 2.53), while hsTnI (OR 0.94; 95 % CI 0.57, 1.52), NT-proBNP (OR 1.10; 95 % 0.70, 1.71), and hsCRP (OR 1.20; 95 % CI 0.76, 1.83) were not. 

Conclusion: Elevated hsTnT concentrations are found in patients with cardiac allograft vasculopathy and in patients with coronary artery disease. In addition, elevated natriuretic peptides point to increased cardiac load in allograft vasculopathy, but not in coronary artery disease.


Figure 1: Odds ratios per standard deviation for high-sensitivity troponin T and I, N-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein in cardiac allograft vasculopathy and atherosclerotic coronary artery disease

*log-transformed. Abbreviations: High-sensitivity troponin T and I (hsTnT/I), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), Odds ratios (OR), standard deviation (SD), confidence interval (CI), cardiac allograft vasculopathy (CAV), atherosclerotic coronary artery disease (CAD). 
https://dgk.org/kongress_programme/jt2023/aP925.html