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Abstract: Poster Presentations |

N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE IS A UNIQUE MARKER OF POOR SURVIVAL IN SCLERODERMA-RELATED PULMONARY ARTERIAL HYPERTENSION FREE TO VIEW

Stephen C. Mathai, MD*; Monica Bueso, MD; Laura K. Hummers, MD; Danielle Boyce, MPH; Noah Lechtzin, MD; Jerome LePavec, MD; Hunter Champion, MD; Fredrick M. Wigley, MD; Reda E. Girgis, MBBCh; Paul M. Hassoun, MD
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Johns Hopkins University School of Medicine, Baltimore, MD


Chest


Chest. 2009;136(4_MeetingAbstracts):54S. doi:10.1378/chest.08-2133
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Abstract

PURPOSE:  Survival in pulmonary arterial hypertension (PAH) related to systemic sclerosis (PAH-SSc) is worse than idiopathic PAH (IPAH) for unclear reasons, but is potentially related to differential neurohormonal responses to cardiac stressors. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of neurohormonal activation that is useful in the diagnosis and prognosis of various forms of PAH. We sought to characterize and compare NT-proBNP in a cohort of PAH-SSc and IPAH patients.

METHODS:  NT-proBNP samples were collected within one week of right heart catheterization from PAH-SSc and IPAH patients who were followed prospectively; levels were compared and correlated with hemodynamic variables. Cox proportional hazard models were created to assess the predictive value of NT-proBNP.

RESULTS:  Ninety-eight patients (55 PAH-SSc, 43 IPAH) were followed for a median of 722 days (range 90–1389). Nearly half were on specific PAH-therapy at enrollment (45/98). Hemodynamics were similar between groups, except for lower mPAP in the PAH-SSc group. NT-proBNP levels were significantly higher in PAH-SSc (3419 ± 3784 vs. 1393 ± 1633 pg/mL, p < 0.01), and were more closely related to hemodynamic variables in PAH-SSc than IPAH. Twenty-eight patients (20 PAH-SSc, 8 IPAH) died. NT-proBNP strongly predicted survival (HR 3.18; p < 0.01) in the overall cohort; however when stratified by group, predicted survival only in PAH-SSc (HR 3.07, p < 0.01 vs. 2.02, p = 0.29 in IPAH).

CONCLUSION:  NT-proBNP levels are significantly higher in PAH-SSc than IPAH despite less severe hemodynamic perturbations. In this cohort, NT-proBNP was a strong predictor of survival only in PAH-SSc, suggesting that neurohormonal regulation may differ between PAH-SSc and IPAH.

CLINICAL IMPLICATIONS:  Elevations in NT-proBNP levels in PAH-SSc compared to IPAH despite less severe hemodynamic pertubations suggest differential neurohormonal responses to cardiac stressors. Future studies are needed to confirm these finding and to elucidate underlying mechanisms.

DISCLOSURE:  Stephen Mathai, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, November 3, 2009

12:45 PM - 2:00 PM


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