title: NT-proBNP as a tool to stratify disease severity in pulmonary arterial hypertension.
abstract: The recent development of treatment modalities for patients with idiopathic pulmonary arterial hypertension has been based on the evaluation of many different markers such as functional capacity, addressed by NYHA classification, six-minute walk test (6MWT) and hemodynamic parameters. The aim of this study was to evaluate the correlation of N-terminal fragment (NT-proBNP) with other markers in IPAH and its potential for patient stratification. We studied 42 IPAH patients consecutively evaluated through right heart catheterization in the absence of any specific treatment for pulmonary hypertension. Blood samples, clinical evaluation and 6MWF distance were collected at baseline. The levels of NT-proBNP showed a high correlation with hemodynamic parameters, such as pulmonary vascular resistance (r=0.80, P<0.001). A significant difference was found among patients with different functional classes, addressed by NYHA classification (P< 0.02 for all groups comparison). The discriminant analysis reinforced the ability of NT-proBNP to stratify patients according to NYHA functional class. Compared to the other variables studied (hemodynamics and 6MWT), NT-proBNP had the lowest level of overlap in the stratification of IPAH patients. We conclude that NT-proBNP differs among the different functional classes and correlates with other measures of disease severity, although its role in predicting survival still needs to be addressed.
authors.affiliation: Pulmonary Division, Pulmonary Hypertension Unit, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil. rgrsz@uol.com.br
authors.forename: Rogerio
authors.initials: R
authors.lastname: Souza
authors.forename: Carlos
authors.initials: C
authors.lastname: Jardim
authors.forename: Caio
authors.initials: C
authors.lastname: Julio Cesar Fernandes
authors.forename: Monica
authors.initials: M
authors.lastname: Silveira Lapa
authors.forename: Rogerio
authors.initials: R
authors.lastname: Rabelo
authors.forename: Marc
authors.initials: M
authors.lastname: Humbert
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014655:Vascular Resistance
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain