title: Plasma brain natriuretic peptide as a biomarker for haemodynamic outcome and mortality following pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
abstract: OBJECTIVE
  In chronic thromboembolic pulmonary hypertension (CTEPH), right ventricular (RV) dysfunction is associated with increased morbidity and mortality following pulmonary endarterectomy. Plasma brain natriuretic peptide (BNP) levels were previously shown to correlate with RV (dys)function. We hypothesized that BNP can be used as a non-invasive biomarker to identify patients at 'high risk' for postoperative morbidity and mortality.
  
  
  METHODS
  We studied the postoperative outcome in 73 consecutive patients. Patients were divided into three groups based on previously determined cut-off levels: BNP <11.5, indicating normal RV function (ejection fraction [EF] ≥45%), BNP >48.5 pmol/l, indicating RV dysfunction (right ventricular ejection fraction <30%) and BNP 11.5-48.5 pmol/l. Postoperative 'bad outcome' was defined as the presence of either residual pulmonary hypertension (PH) or (all-cause) mortality.
  
  
  RESULTS
  Plasma BNP >48.5 pmol/l was shown to be an independent predictor of 'bad outcome'. Compared with BNP <11.5 pmol/l, BNP >48.5 pmol/l identified patients at higher risk for (all-cause) mortality (17 vs 0%; P = 0.009) and residual PH (56 vs 20%; P < 0.004). Also, the durations of mechanical ventilation and intensive care unit stay were significantly longer in patients with BNP >48.5 pmol/ml.
  
  
  CONCLUSIONS
  Plasma BNP levels may be of use as a non-invasive biomarker reflecting RV dysfunction, next to other well-recognized (invasive) parameters, for better preoperative risk stratification of CTEPH patients.
authors.affiliation: Department of Pulmonology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Surie
authors.forename: Herre J
authors.initials: HJ
authors.lastname: Reesink
authors.forename: Mart N
authors.initials: MN
authors.lastname: van der Plas
authors.forename: Maxim
authors.initials: M
authors.lastname: Hardziyenka
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Kloek
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Paul
authors.initials: P
authors.lastname: Bresser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain