Plasma biomarkers outperform echocardiographic measurements for cardiovascular risk prediction in kidney transplant recipients: results of the HOME ALONE study

Insa E Emrich; Anja L Scheuer; Kyrill S Rogacev; Felix Mahfoud; Stefan Wagenpfeil; Danilo Fliser; Stephan H Schirmer; Michael Böhm; Gunnar H Heine

doi:10.1093/ckj/sfab216

Plasma biomarkers outperform echocardiographic measurements for cardiovascular risk prediction in kidney transplant recipients: results of the HOME ALONE study

Clin Kidney J. 2021 Oct 28;15(4):693-702. doi: 10.1093/ckj/sfab216. eCollection 2022 Apr.

Authors

Insa E Emrich¹, Anja L Scheuer², Kyrill S Rogacev³, Felix Mahfoud¹, Stefan Wagenpfeil⁴, Danilo Fliser², Stephan H Schirmer¹, Michael Böhm¹, Gunnar H Heine²

Affiliations

¹ Saarland University Medical Center, Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Homburg, Germany.
² Saarland University Medical Center, Internal Medicine IV, Nephrology and Hypertension, Homburg, Germany.
³ Sana Hanse-Klinikum Wismar, Internal Medicine II, Cardiology, Wismar, Germany.
⁴ Saarland University, Institute for Medical Biometry, Epidemiology and Medical Informatics, Campus Homburg, University Medical Center, Germany.

Abstract

Background: Since kidney transplant recipients (KTRs) have a high cardiovascular disease burden, adequate risk prediction is of importance. Whether echocardiographic parameters and plasma biomarkers, natriuretic peptides [N-terminal pro-B-type natriuretic peptide (NT-proBNP)] and troponin T provide complementary or overlapping prognostic information on cardiovascular events remains uncertain.

Methods: The prospective Heterogeneity of Monocytes and Echocardiography Among Allograft Recipients in Nephrology (HOME ALONE) study followed 177 KTRs for 5.4 ± 1.7 years. Predefined endpoints were hospitalization for acute decompensated heart failure or all-cause death (HF/D) and major atherosclerotic cardiovascular events or all-cause death (MACE/D). At baseline, plasma NT-proBNP, plasma troponin T and echocardiographic parameters [left atrial volume index, left ventricular (LV) mass index, LV ejection fraction, and LV filling pressure] were assessed.

Results: Among all echocardiographic and plasma biomarkers measured, only NT-proBNP was consistently associated with HF/D in univariate and multivariate {third versus first tertile: hazard ratio [HR] 4.20 [95% confidence interval (CI) 1.02-17.27]} analysis, and only troponin T was consistently associated with MACE/D in univariate and multivariate [third versus first tertile: HR 8.15 (95% CI 2.75-24.18)] analysis.

Conclusion: Our data suggest that plasma biomarkers are robust and independent predictors of heart failure and atherosclerotic cardiovascular events after kidney transplantation, whereas standard echocardiographic follow-up does not add to risk prediction.

Keywords: cardiovascular outcomes; echocardiographic parameters; heart failure; kidney transplant recipients; plasma NT-proBNP; plasma troponin T; risk prediction.