The value of B-type natriuretic peptide and big endothelin-1 for detection of severe pulmonary hypertension in heart transplant candidates.
BACKGROUND
Severe pulmonary hypertension (PH) and increased pulmonary vascular resistance (PVR) are important risk factors that predict early postoperative mortality after orthotopic heart transplantation. The aim of our study was to determine the value of B-type natriuretic peptide (BNP) and big endothelin-1 (big ET1) for prediction of severe PH in heart transplant candidates.


METHODS
The study population included 43 potential heart transplant candidates (38 males, mean age 52 +/- 7 years). All underwent repeated right-heart catheterizations (2-5 studies) at an interval of 3-4 months, giving a total of 124 examinations, associated with blood sampling for BNP and big ET1 analysis. Severe PH was defined as the mean pulmonary artery pressure (MPAP) > 40 mmHg.


RESULTS
Significantly high PVR (PVR > 3.0 Wood units and TPG > 15 mmHg) was noted on 12 occasions in 10 patients; always in the presence of severe PH. Low BNP levels (<67 pg/ml) ruled out the presence of severe PH with a 100% sensitivity, however, with a low specificity (34%). An increase in plasma BNP > 30 pg/ml (>40% of initial value) in subjects with a previous MPAP< or =40 mmHg detected development of severe PH with a 100% sensitivity and an 80-88% specificity. As a total of 58% of patients presented repeatedly with MPAP< or =40 mmHg, serial BNP testing could reduce the need for hemodynamic studies in this subgroup down to 12-20%.


CONCLUSIONS
Serial BNP testing in hemodynamically stable heart transplant candidates with MPAP< or =40 mmHg allows reliable detection of development of severe PH, and may significantly reduce the need for repeated right-heart catheterizations in these patients.
Kubánek
Milos
M
Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. mikb@medicon.cz
Málek
Ivan
I
Kautzner
Josef
J
Hegarová
Markéta
M
Wiendl
Martin
M
Lupínek
Petr
P
Karasová
Ludmila
L
Lánská
Vera
V
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D011863:Radioimmunoassay; D012189:Retrospective Studies; D012720:Severity of Illness Index
D015415:Biomarkers; D019332:Endothelin-1; D020097:Natriuretic Peptide, Brain