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Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension.
Chest. 2006 May; 129(5):1313-21.Chest

Abstract

STUDY OBJECTIVES

Baseline prognostic assessment in patients with pulmonary hypertension (PH) may help in the selection of treatment. High plasma levels of natriuretic peptide type B have been reported in patients with right ventricular (RV) dysfunction and suggest poor prognosis in patients with idiopathic pulmonary arterial hypertension (IPAH). We prospectively assessed the correlation of N-terminal brain natriuretic peptide (NT-proBNP) with echocardiographic and hemodynamic indexes of RV function as well as with baseline functional status and long-term survival of PH patients.

PATIENTS AND DESIGN

Fifty-five consecutive patients with a mean (+/- SD) age of 41 +/- 15 years and severe PH (including 36 patients with IPAH) were followed up for up to 36 months. Serum samples for NT-proBNP were secured, and 6-min walk test (6 MWT), RV catheterization, and echocardiography were all performed on the same day, before the introduction of targeted treatment.

RESULTS

The median baseline serum NT-proBNP concentration was 1,674 pg/mL (range, 51 to 10,951 pg/mL). NT-proBNP concentration correlated with 6MWT distance (r = 0.6; p < 0.001), cardiac index, pulmonary vascular resistance, and right atrial pressure (RAP), but not with pulmonary arterial pressure. NT-proBNP levels were also related to the ratio of the diastolic area of the RV and the LV, and to pericardial effusion during echocardiography. Receiver operating characteristic analysis identified > or = 1,400 pg/mL as the best NT-proBNP threshold predicting fatal outcome for the entire study group as well as for IPAH patients (sensitivity, 88% and 100%, respectively; specificity, 53% and 56%, respectively). In multivariate analysis, NT-proBNP, troponin T, and RAP were identified as independent factors for poor prognosis for the entire study group, while only NT-proBNP and RAP were identified as markers for poor prognosis in the IPAH subgroup.

CONCLUSIONS

NT-proBNP level is related to the right heart morphology and dysfunction in PH patients. A serum NT-proBNP level of > or = 1,400 pg/mL was found to be useful in identifying patients with poor long-term prognosis both in the whole studied group and in the IPAH subgroup.

Authors+Show Affiliations

Department of Chest Medicine, National Research Institute of Tuberculosis and Lung Diseases, Ul Plocka 26, 01-138 Warsaw, Poland. a.fijalkowska@igichp.edu.plNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16685024

Citation

Fijalkowska, Anna, et al. "Serum N-terminal Brain Natriuretic Peptide as a Prognostic Parameter in Patients With Pulmonary Hypertension." Chest, vol. 129, no. 5, 2006, pp. 1313-21.
Fijalkowska A, Kurzyna M, Torbicki A, et al. Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. Chest. 2006;129(5):1313-21.
Fijalkowska, A., Kurzyna, M., Torbicki, A., Szewczyk, G., Florczyk, M., Pruszczyk, P., & Szturmowicz, M. (2006). Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. Chest, 129(5), 1313-21.
Fijalkowska A, et al. Serum N-terminal Brain Natriuretic Peptide as a Prognostic Parameter in Patients With Pulmonary Hypertension. Chest. 2006;129(5):1313-21. PubMed PMID: 16685024.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. AU - Fijalkowska,Anna, AU - Kurzyna,Marcin, AU - Torbicki,Adam, AU - Szewczyk,Grzegorz, AU - Florczyk,Michal, AU - Pruszczyk,Piotr, AU - Szturmowicz,Monika, PY - 2006/5/11/pubmed PY - 2006/5/31/medline PY - 2006/5/11/entrez SP - 1313 EP - 21 JF - Chest JO - Chest VL - 129 IS - 5 N2 - STUDY OBJECTIVES: Baseline prognostic assessment in patients with pulmonary hypertension (PH) may help in the selection of treatment. High plasma levels of natriuretic peptide type B have been reported in patients with right ventricular (RV) dysfunction and suggest poor prognosis in patients with idiopathic pulmonary arterial hypertension (IPAH). We prospectively assessed the correlation of N-terminal brain natriuretic peptide (NT-proBNP) with echocardiographic and hemodynamic indexes of RV function as well as with baseline functional status and long-term survival of PH patients. PATIENTS AND DESIGN: Fifty-five consecutive patients with a mean (+/- SD) age of 41 +/- 15 years and severe PH (including 36 patients with IPAH) were followed up for up to 36 months. Serum samples for NT-proBNP were secured, and 6-min walk test (6 MWT), RV catheterization, and echocardiography were all performed on the same day, before the introduction of targeted treatment. RESULTS: The median baseline serum NT-proBNP concentration was 1,674 pg/mL (range, 51 to 10,951 pg/mL). NT-proBNP concentration correlated with 6MWT distance (r = 0.6; p < 0.001), cardiac index, pulmonary vascular resistance, and right atrial pressure (RAP), but not with pulmonary arterial pressure. NT-proBNP levels were also related to the ratio of the diastolic area of the RV and the LV, and to pericardial effusion during echocardiography. Receiver operating characteristic analysis identified > or = 1,400 pg/mL as the best NT-proBNP threshold predicting fatal outcome for the entire study group as well as for IPAH patients (sensitivity, 88% and 100%, respectively; specificity, 53% and 56%, respectively). In multivariate analysis, NT-proBNP, troponin T, and RAP were identified as independent factors for poor prognosis for the entire study group, while only NT-proBNP and RAP were identified as markers for poor prognosis in the IPAH subgroup. CONCLUSIONS: NT-proBNP level is related to the right heart morphology and dysfunction in PH patients. A serum NT-proBNP level of > or = 1,400 pg/mL was found to be useful in identifying patients with poor long-term prognosis both in the whole studied group and in the IPAH subgroup. SN - 0012-3692 UR - https://www.unboundmedicine.com/medline/citation/16685024/Serum_N_terminal_brain_natriuretic_peptide_as_a_prognostic_parameter_in_patients_with_pulmonary_hypertension_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)50712-5 DB - PRIME DP - Unbound Medicine ER -