PURPOSE: The goal of this study was to evaluate the predicitive value of brain natriuretic peptide (BNP) for adverse cardiovascular events (ACE) in pulmonary arterial hypertension (PAH) patients.
METHODS: We conducted a prospective, controlled trial. Study population: Patients with idiopathic PAH, or PAH associated with congenital cardiac diseases, collagen vascular diseases, anorexigen use, pulmonary embolism and human immunodeficiency virus infection with mean pulmonary arterial pressure (mPAP) >25 mmHg by right cardiac catheterization. In all patients determination of BNP and 6 minute walk distance test (6MWDT) were done the same day. Exclusion criteria was: absense of BNP determination. Control group: healhty patients paired by gender, age and weight. Statistical analysis: Student's t, logistic and multiple regression, Wilcoxon test, proportional risk Cox model, square chi.
RESULTS: From March to November 2007, 85 patients, 20% male and 80% female with a mean age of 37.8 ±14 years were included in the study. PAH was associated with cardiac congenital diseases 40% (ASD 29%, VSD 6%, PDA 5%), idiopathic 40%, collagen vascular diseases 12%, pulmonary embolism 4%, anorexigen use 2%, immunodeficiency virus infection 2%. In all patients we evaluated ACE: right ventricular dysfunction, heart failure, cardiogenic shock and death. mPAP 90.40 ±27.50 mmHg, 6MWDT 419 ±103.8 meters, BNP 167.66 ±218.29 pg/mL and control group (33 patients) BNP 12.11 ±8.9 pg/mL (p<0.0001). Simple regression analysis identified BNP as an independent variable for ACE (p<0.001). The logistic regression models and multivariate analysis which included BNP had the greatest correlation (r=0.48) compared to historic models.
CONCLUSION: In this group of patients with PAH, BNP was an independent variable with a high predictive value for ACE.
CLINICAL IMPLICATIONS: This tool could improve the risk stratification and identify risk patients in an attempt to develop strategies for primary or secondary prevention measures.
DISCLOSURE: Edgar Garcia Badillo, No Financial Disclosure Information; No Product/Research Disclosure Information