title: Brain natriuretic peptide and exercise capacity in lung fibrosis and pulmonary hypertension.
abstract: Pulmonary hypertension (PH) can develop in lung fibrosis, and contributes to increased morbidity and mortality. Noninvasive parameters in the evaluation of PH in lung disease could aid in the management of these subjects. In this study, we aimed to characterize the role of brain natriuretic peptide (BNP) and the six-minute walk distance (6-MWD) in the assessment of pulmonary hypertension (PH) in subjects with lung fibrosis. Subjects with lung fibrosis and elevated BNP levels (n = 20) had significantly more severe PH during right heart catheterization than those with lung fibrosis, and normal BNP levels (mean pulmonary arterial pressure (40.85 +/- 3.2 mm Hg vs. 23.42+/-1.44 mm Hg, respectively) (n = 19) (p < 0.001). Significant correlations between lung volumes and BNP concentrations were not observed. A weak correlation existed between capillary pO(2) and 6-MWD (r = 0.42; p < 0.001). The presence of moderate-severe PH was associated with significant reduction of the 6-MWD. BNP concentrations predicted moderate-severe PH with 100% sensitivity and high specificity (89%). We conclude that BNP is an excellent marker for the presence of PH in patients with lung fibrosis. In addition, our data suggest that PH contributes significantly to exercise limitation in patients with severe lung fibrosis, raising the possibility that treatment of PH may be beneficial in these patients.
authors.affiliation: Division of Pulmonary Diseases, Department of Internal Medicine I, Ludwig Maximilians University, Klinikum Grosshadern, Munich Marchioninistr. 15, 81377 Munich, Germany. hleuchte@med.uni-muenchen.de
authors.forename: Hanno H
authors.initials: HH
authors.lastname: Leuchte
authors.forename: Claus
authors.initials: C
authors.lastname: Neurohr
authors.forename: Rainer
authors.initials: R
authors.lastname: Baumgartner
authors.forename: Michael
authors.initials: M
authors.lastname: Holzapfel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Giehrl
authors.forename: Michael
authors.initials: M
authors.lastname: Vogeser
authors.forename: Jürgen
authors.initials: J
authors.lastname: Behr
mesh_terms: D015415:Biomarkers / Q000097:blood; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000145:classification* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011658:Pulmonary Fibrosis / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain