Natriuretic peptides for the prediction of severely impaired peak VO2 in patients with lung disease.
BACKGROUND
B-type natriuretic peptide (BNP) is a predictor of death in patients with lung disease. We hypothesised that in patients with lung disease, BNP and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) could predict a peak VO(2)<15 ml/kg/min, which is the proposed cut-off indicating an increased risk of perioperative complications during lung resection surgery.


METHODS
BNP and NT-proBNP were measured in 85 patients with a variety of pulmonary pathologies undergoing cardiopulmonary exercise testing and fulfilling criteria for appropriate effort.


RESULTS
BNP [69 (42-270) vs. 33 (15-65)pg/ml; p=0.001] and NT-proBNP [290 (129-1075) vs. 65 (21-129)pg/ml; p<0.001] were higher in patients with peak VO(2)<15 ml/kg/min (n=27) as compared to those with peak VO(2)> or =15 ml/kg/min (n=58). Apart from the forced expiratory volume within the first second (FEV(1)), body mass index (BMI), diabetes, and the alveolo-arterial oxygen pressure difference [D(A-a)O(2); only in the BNP model], BNP or NT-proBNP respectively were independent predictors of peak VO(2)<15 ml/kg/min. The areas under the receiver-operator-characteristics curve (AUC) for BNP and NT-proBNP to predict a peak VO(2)<15 ml/kg/min were 0.73 and 0.80 respectively. A five-item (BNP) or four-item (NT-proBNP) score including BMI, FEV(1), diabetes, D(A-a)O(2), and BNP/NT-proBNP had an AUC of 0.87 and 0.88 respectively for the prediction of peak VO(2)<15ml/kg/min.


CONCLUSIONS
In patients with lung disease, BNP or NT-proBNP is independently associated with low peak VO(2). A simple score based on spirometry, blood gases and BNP or NT-proBNP has a high accuracy for the prediction of a peak VO(2)<15 ml/kg/min.
Baker IDI Heart and Diabetes Institute, St Kilda Road Central, Melbourne, Victoria 8008, Australia. micha.maeder@bluewin.ch
Micha T
MT
Maeder
Martin H
MH
Brutsche
Andreas
A
Christ
Tobias
T
Reichlin
Daniel
D
Staub
Markus
M
Noveanu
Tobias
T
Breidthardt
Mihael
M
Potocki
Christian
C
Mueller
D015415:Biomarkers / Q000097:blood; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000097:blood* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D013147:Spirometry
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D010100:Oxygen