title: Associations of circulating natriuretic peptides with haemodynamics in precapillary pulmonary hypertension.
abstract: BACKGROUND
  While N-terminal B-type natriuretic peptide (NT-proBNP) has been examined extensively in pulmonary hypertension (PH), limited data exists on the subtype A, C and D. The aim of this prospective pilot study was a head-to-head comparison of NPs in respect to haemodynamic parameters and the influence of renal function.
  
  
  METHODS
  Plasma samples were drawn during routine right heart catheterization in 62 patients with precapillary PH and 20 control patients. MR-proANP measurements were performed on the automated Kryptor platform, NT-proBNP by CLIA, NT-proCNP and DNP levels by ELISA. Results are expressed as median [range] and tested non-parametrically. Non-parametric locally linear multiple regression was performed to determine the influence of renal function on NP levels. P-values <0.05 were considered significant.
  
  
  RESULTS
  Patients with PH had significantly higher MR-proANP and NT-proBNP levels. NT-proCNP showed a trend to higher levels, while DNP did not differ from control subjects. Both MR-proANP and NT-proBNP were associated with cardiac index (CI), right atrial pressure (RAP), mean pulmonary artery pressure (PAPm) and pulmonary vascular resistance index (PVRI). NT-proCNP was associated with RAP, while DNP showed no associations with haemodynamic variables. Associations of haemodynamic parameters with NPs were weakened in patients with in elevated serum creatinine and showed increased regression slopes.
  
  
  CONCLUSIONS
  MR-proANP demonstrated equivalent associations with haemodynamics compared to NT-proBNP, but both markers depend on intact renal function. NT-proCNP was correlated with RAP and renal function, while DNP showed no associations. Larger studies should evaluate MR-proANP as candidate prognostic biomarker in PH.
authors.affiliation: Saarland University, Dep. of Internal Medicine V, Pulmonology, Allergology, Respiratory Intensive Care Medicine, Kirrberger Strasse, D-66424, Homburg/Saar, Germany. Electronic address: ralfkaiser@gmx.net.
authors.forename: Ralf
authors.initials: R
authors.lastname: Kaiser
authors.affiliation: Saarland University, Dep. of Gastroenterology, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Grotemeyer
authors.affiliation: Saarland University, Dep. of Internal Medicine V, Pulmonology, Allergology, Respiratory Intensive Care Medicine, Kirrberger Strasse, D-66424, Homburg/Saar, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lepper
authors.affiliation: Saarland University, Dep. of Gastroenterology, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Stokes
authors.affiliation: Saarland University, Dep. of Internal Medicine V, Pulmonology, Allergology, Respiratory Intensive Care Medicine, Kirrberger Strasse, D-66424, Homburg/Saar, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Bals
authors.affiliation: Saarland University, Dep. of Internal Medicine V, Pulmonology, Allergology, Respiratory Intensive Care Medicine, Kirrberger Strasse, D-66424, Homburg/Saar, Germany.
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D020098:Natriuretic Peptide, C-Type / Q000097:blood; D045265:Natriuretic Peptides / Q000097:blood* / Q000502:physiology; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides; D010446:Peptide Fragments; C480579:amino-terminal pro-C-type natriuretic peptide, human; C552580:midregional pro-atrial natriuretic peptide, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D020098:Natriuretic Peptide, C-Type; D009320:Atrial Natriuretic Factor
keywords: Haemodynamics; Natriuretic peptides; Pulmonary hypertension; Renal function