title: An exploratory panel of biomarkers for risk prediction in pulmonary hypertension: emerging role of CT-proET-1.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a rare, deadly condition. Although risk stratification is extremely important for assessment of prognosis and to guide therapy, there is lack of evidence concerning the role of novel biomarkers. In a pivotal study, we sought to comparatively investigate the predictive power of several new biomarkers in PAH.
  
  
  METHODS
  Patients with prevalent PAH were enrolled in the study protocol, which included clinical, functional and echocardiographic assessment. Blood samples were collected at baseline for determination of NT-proBNP, CT-proET-1, MR-proANP, MR-proADM, copeptin and troponin I. Patients were clinically followed-up up to 12 months for first occurrence of hospital admission due to PAH-related clinical worsening, heart/lung transplantation or all-cause mortality.
  
  
  RESULTS
  Among the 28 included patients the pre-specified end-point occurred in 8 (29% event rate). There were higher baseline levels of CT-proET-1, copeptin, MR-proANP, NT-proBNP and troponin I in patients who reached the composite end-point. They also had larger right atria. In multivariate Cox regression, CT-proET-1 was the only biomarker associated with increased hazard of reaching the primary composite end-point (hazard ratio per tertile increase = 10.1; 95% CI 2.0 to 50.6).
  
  
  CONCLUSIONS
  CT-proET-1 provided prognostic information independent of other biomarkers. Importantly, we have provided the first evidence that CT-proET-1 may be superior to commonly used biomarkers.
authors.affiliation: Department of Cardiology I, Lisbon Academic Medical Centre, Lisbon, Portugal. Electronic address: silvamarques.j@gmail.com.
authors.forename: João
authors.initials: J
authors.lastname: Silva Marques
authors.forename: Susana Robalo
authors.initials: SR
authors.lastname: Martins
authors.forename: Carina
authors.initials: C
authors.lastname: Calisto
authors.forename: Susana
authors.initials: S
authors.lastname: Gonçalves
authors.forename: Ana Gomes
authors.initials: AG
authors.lastname: Almeida
authors.forename: João Carvalho
authors.initials: JC
authors.lastname: de Sousa
authors.forename: Fausto José
authors.initials: FJ
authors.lastname: Pinto
authors.forename: António Nunes
authors.initials: AN
authors.lastname: Diogo
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004452:Echocardiography; D019332:Endothelin-1 / Q000097:blood*; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; C557077:C-terminal proendothelin-1; D019332:Endothelin-1; D006020:Glycopeptides; D010446:Peptide Fragments; D019210:Troponin I; C048197:copeptins; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor
keywords: biomarkers; copeptin; endothelin-1; natriuretic peptides; prognosis; pulmonary hypertension; troponin