Miscellaneous
Usefulness of Serial N-Terminal Pro–B-Type Natriuretic Peptide Measurements for Determining Prognosis in Patients With Pulmonary Arterial Hypertension

https://doi.org/10.1016/j.amjcard.2011.07.025Get rights and content

Previous studies have shown the prognostic benefit of N-terminal pro–brain natriuretic peptide (NT–pro-BNP) in pulmonary arterial hypertension (PAH) at time of diagnosis. However, there are only limited data on the clinical utility of serial measurements of the inactive peptide NT–pro-BNP in PAH. This study examined the value of serial NT–pro-BNP measurements in predicting prognosis PAH. We retrospectively analyzed all available NT–pro-BNP plasma samples in 198 patients who were diagnosed with World Health Organization group I PAH from January 2002 through January 2009. At time of diagnosis median NT–pro-BNP levels were significantly different between survivors (610 pg/ml, range 6 to 8,714) and nonsurvivors (2,609 pg/ml, range 28 to 9,828, p <0.001). In addition, NT–pro-BNP was significantly associated (p <0.001) with other parameters of disease severity (6-minute walking distance, functional class). Receiver operating curve analysis identified ≥1,256 pg/ml as the optimal NT–pro-BNP cutoff for predicting mortality at time of diagnosis. Serial measurements allowed calculation of baseline NT–pro-BNP (i.e., intercept obtained by back-extrapolation of concentration–time graph), providing a better discrimination between survivors and nonsurvivors than NT–pro-BNP at time of diagnosis alone (p = 0.010). Furthermore, a decrease of NT–pro-BNP of >15%/year was associated with survival. In conclusion, a serum NT–pro-BNP level ≥1,256 pg/ml at time of diagnosis identifies poor outcome in patients with PAH. In addition, a decrease in NT–pro-BNP of >15%/year is associated with survival in PAH.

Section snippets

Methods

Serial cardiac biomarker measurement had been introduced at the department of pulmonology of VU Medical Center of Amsterdam (The Netherlands) since 2002 as part of routine clinical assessment. We retrospectively identified all patients who were diagnosed with World Health Organization group I PAH from November 2002 through September 2009. The study was approved by our institutional review board and ethics committee. All World Health Organization group I subgroups with ≥1 NT–pro-BNP measurement

Results

Baseline characteristics of all 198 patients are presented in Table 1. The population was predominantly women (71.2%) with a mean age of 54 ± 17 years. Fifty-six percent had idiopathic PAH and >58% were in modified NYHA/World Health Organization functional classes III and VI. PAH baseline therapies included prostacyclin analogs in 26 (13.1%), endothelin receptor antagonists in 118 (59.5%), and phosphodiesterase-5 inhibitors in 40 patients (20.2%). Eight patients received combination PAH

Discussion

This is the largest study to date to assess the prognostic value of using all available single and repeated measurements of NT–pro-BNP in patients with PAH. The major findings can be summarized as follows. (1) A serum NT–pro-BNP level ≥1,256 pg/ml at time of diagnosis identified poor outcome in patients with PAH. (2) Available longitudinal NT–pro-BNP measurements provide additional prognostic value to a calculated baseline NT–pro-BNP value. In particular, after accounting for biological

References (25)

  • K.G. Blyth et al.

    NT-proBNP can be used to detect right ventricular systolic dysfunction in pulmonary hypertension

    Eur Respir J

    (2007)
  • C.T. Gan et al.

    NT-proBNP reflects right ventricular structure and function in pulmonary hypertension

    Eur Respir J

    (2006)
  • Cited by (81)

    • Prognostic value of brain natriuretic peptides in patients with pulmonary arterial hypertension: A systematic review and meta-analysis

      2022, American Heart Journal
      Citation Excerpt :

      We excluded 2860 articles based on title and abstract screening. Fifty-two articles were carefully read in full text after which 16 studies were included in our systematic review and meta-analysis.11,23-35 The Cohen statistic K for agreement on study inclusion was 0.84.

    • Prognostic value of improvement endpoints in pulmonary arterial hypertension trials: A COMPERA analysis

      2022, Journal of Heart and Lung Transplantation
      Citation Excerpt :

      Still, the prognostic significance of improvements in NT-proBNP is unclear, and previous studies have yielded conflicting results. Mauritz et al. reported that a 15% decline in NT-proBNP translated into better outcomes,30 whereas Fritz and al. found that changes in BNP were not predictive of subsequent survival.13 In the present study, absolute declines in NT-proBNP up to 800 ng/l were not prognostic, while relative declines by ≥35% were associated with improved survival.

    • Management of the infant with bronchopulmonary dysplasia

      2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh Edition
    • Serial Measurements of N-Terminal Pro-B-Type Natriuretic Peptide Serum Level for Monitoring Pulmonary Arterial Hypertension in Children

      2020, Journal of Pediatrics
      Citation Excerpt :

      Here we report that a doubling of NT-proBNP level compared with the first measurement at any time in the disease course is predictive of worse survival. This observation is in line with findings in adults with PAH and adults with congenital heart disease, showing that serial NT-proBNP measurements provide clinically important additional prognostic information relative to a single baseline measurement.17,18 We further found that children with an increase of >10% from first measurement to first follow-up visit had worse survival compared with those with a ≤10% increase, independent of the absolute NT-proBNP value at first measurement.

    View all citing articles on Scopus

    Dr. Vonk-Noordegraaf was supported by the Netherlands Organisation for Scientific Research (NWO-VIDI, Amsterdam, Netherlands).

    View full text