MiscellaneousUsefulness of Serial N-Terminal Pro–B-Type Natriuretic Peptide Measurements for Determining Prognosis in Patients With Pulmonary Arterial Hypertension
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
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Dr. Vonk-Noordegraaf was supported by the Netherlands Organisation for Scientific Research (NWO-VIDI, Amsterdam, Netherlands).