title: Pro-brain natriuretic peptide as marker of cardiovascular or pulmonary causes of dyspnea in patients with terminal parenchymal lung disease.
abstract: BACKGROUND
  Increased plasma concentrations of pro-atrial natriuretic peptide (proANP) and pro-brain natriuretic peptide (proBNP) are features of left ventricular impairment. However, concentrations of proANP and proBNP in patients with isolated terminal parenchymal lung disease are not known. Therefore, we measured the plasma concentrations of natriuretic precursor peptides in patients with terminal parenchymal lung disease who had normal left ventricular function and who were referred for evaluation for lung transplantation.
  
  
  METHODS
  We measured plasma N-terminal proANP and proBNP in patients undergoing right heart catheterization (n = 50) and related results to hemodynamic variables obtained during catheterization.
  
  
  RESULTS
  Plasma proBNP concentrations were unaffected in patients with terminal parenchymal lung disease and normal left ventricular function (median, 2.5 pmol/liter; range, 0-22; upper reference limit, 15 pmol/liter). In contrast, patients with primary pulmonary hypertension displayed more than a 40-fold increase in plasma proBNP concentrations (median, 107 pmol/liter vs 2.5 pmol/liter, p < 0.0001). Plasma N-terminal proANP increased moderately (median, 664 pmol/liter; range, 36-1620; upper reference limit, 600 pmol/liter) but correlated to plasma proBNP concentrations (r = 0.47, p < 0.0001). Finally, regional vascular proBNP concentrations revealed the heart as the secretory site.
  
  
  CONCLUSIONS
  Our findings strongly support the contention that natriuretic peptide measurements are efficient markers for cardiovascular causes of dyspnea. Moreover, our results eliminate natriuretic peptides as markers of moderate pulmonary hypertension in patients with terminal parenchymal lung disease.
authors.affiliation: Medical Department B, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Goetze
authors.forename: Regitze
authors.initials: R
authors.lastname: Videbaek
authors.forename: Soren
authors.initials: S
authors.lastname: Boesgaard
authors.forename: Jan
authors.initials: J
authors.lastname: Aldershvile
authors.forename: Jens F
authors.initials: JF
authors.lastname: Rehfeld
authors.forename: Jorn
authors.initials: J
authors.lastname: Carlsen
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications*; D004417:Dyspnea / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011863:Radioimmunoassay
chemical_list: D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain