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Original Research: PULMONARY HYPERTENSION |

Serum N-Terminal Brain Natriuretic Peptide as a Prognostic Parameter in Patients With Pulmonary Hypertension*

Anna Fijalkowska, MD; Marcin Kurzyna, MD; Adam Torbicki, MD; Grzegorz Szewczyk, MD; Michał Florczyk, MD; Piotr Pruszczyk, MD; Monika Szturmowicz, MD, FCCP
Author and Funding Information

*From the Department of Chest Medicine (Drs. Fijalkowska, Kurzyna, Torbicki, Florczyk, and Szturmowicz), National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland; and the Departments of General and Experimental Pathology (Dr. Szewczyk), and Internal Medicine, Hypertension, and Angiology (Dr. Pruszczyk), Medical University of Warsaw, Poland.

Correspondence to: Anna Fijalkowska, MD, Department of Chest Medicine, National Research Institute of Tuberculosis and Lung Diseases, Ul Plocka 26, 01-138 Warsaw, Poland; e-mail: a.fijalkowska@igichp.edu.pl



Chest. 2006;129(5):1313-1321. doi:10.1378/chest.129.5.1313
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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 ≥ 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 ≥ 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.

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