Brain natriuretic peptide as noninvasive marker of the severity of right ventricular dysfunction in chronic thromboembolic pulmonary hypertension.
BACKGROUND
Right ventricular (RV) dysfunction is associated with increased morbidity and mortality in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo pulmonary endarterectomy (PEA). We studied whether plasma brain natriuretic peptide (BNP) levels can be used to identify RV dysfunction in CTEPH patients. Therefore, plasma BNP levels were studied in relation to cardiac remodeling and function as determined by cardiac magnetic resonance imaging (MRI).


METHODS
Thirty-eight patients with CTEPH (55 +/- 15 years), and ten healthy controls (46 +/- 15 years) were studied. The BNP was determined by an immunoradiometric assay.


RESULTS
The CTEPH patients had a mean pulmonary artery pressure of 49 +/- 13 mm Hg, cardiac index 2.1 +/- 0.7 l x min(-1) x m(-2), and pulmonary vascular resistance of 867 +/- 432 dynes x s x cm(-5). In CTEPH patients, compared with controls, right ventricular (RV) remodeling was demonstrated. In the patients, BNP was increased and correlated (all p < 0.0001; Spearman rank test) with MRI parameters of RV remodeling and function: end diastolic (r = 0.71) and end systolic (r = 0.74) volumes, RV mass (r = 0.68), leftward ventricular septal bowing (r = -0.80) and ejection fraction (EF; r = -0.81). By receiver operating curve analysis, BNP levels of 11.5 picomole (pmol)/L and 48.5 pmol/L, respectively, detected RV dysfunction as defined by RVEF less than 0.45 and less than 0.30, respectively, with high sensitivity and specificity. Hemodynamically, BNP levels greater than 48.5 pmol/L identified the most severely affected patients.


CONCLUSIONS
In CTEPH patients, BNP levels correlate with RV remodeling and can be used to identify RV dysfunction. Future studies are warranted on the role of BNP to identify "high risk" CTEPH patients and its relation to postoperative hemodynamic outcome, RV failure, and mortality.
Reesink
Herre J
HJ
Department of Pulmonology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Tulevski
Igor I
II
Marcus
J Tim
JT
Boomsma
Frans
F
Kloek
Jaap J
JJ
Vonk Noordegraaf
Anton
A
Bresser
Paul
P
D000328:Adult; D000368:Aged; D017073:Atherectomy; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D002908:Chronic Disease; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D013923:Thromboembolism / Q000097:blood* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000175:diagnosis*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain