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J Am Coll Cardiol, 2004; 43:764-770, doi:10.1016/j.jacc.2003.09.051
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: BIOMARKERS

Clinical significance of brain natriuretic peptide in primary pulmonary hypertension

Hanno H. Leuchte, MD*,*, Michael Holzapfel*, Rainer A. Baumgartner*, Isabelle Ding, MD*, Claus Neurohr, MD*, Michael Vogeser, MD{dagger}, Tilman Kolbe, MD*, Martin Schwaiblmair, MD* and Jürgen Behr, MD*

* Division of Pulmonary Diseases, Department of Internal Medicine I, Munich, Germany
{dagger} Department of Clinical Chemistry, Ludwig Maximilians University, Klinikum Grosshadern, Munich, Germany

Manuscript received June 27, 2003; revised manuscript received September 4, 2003, accepted September 11, 2003.

* Reprint requests and correspondence: Dr. Hanno H. Leuchte, Division of Pulmonary Diseases, Department of Internal Medicine I, Ludwig Maximilians University, Klinikum Grosshadern, Munich Marchioninistr. 15, 81377 Munich, Germany.
hleuchte{at}helios.med.uni-muenchen.de

OBJECTIVES: The aim of this study was to investigate the potential role of brain natriuretic peptide (BNP) levels in the assessment of functional status and right heart performance in primary pulmonary hypertension (PPH).

BACKGROUND: Primary pulmonary hypertension is a progressive disease leading to right heart failure and death. Right heart catheterization and maximal or submaximal exercise tests are employed to assess the course of the disease and the effect of therapeutic interventions. Additional noninvasive and reproducible parameters would be helpful to assess the status of patients with PPH. The natriuretic peptide system is up-regulated in PPH patients. Brain natriuretic peptide (BNP) is produced from the cardiac ventricles and elevated in PPH. The aim of our study was to evaluate the clinical significance of BNP in PPH patients.

METHODS: Correlation analysis was performed for plasma BNP levels of 28 PPH patients and World Health Organization (WHO) functional class (WHO-class), distance walked in 6 min, peak oxygen uptake (peak VO2), and oxygen pulse during spiroergometry and various hemodynamic parameters, including pulmonary vascular resistance (PVR), pulmonary artery pressure (PAP), right atrial pressure (RAP), and cardiac index.

RESULTS: The BNP levels were inversely correlated with the 6-min walk (r = –0.70; p < 0.001) and peak VO2 (r = –0.61; p < 0.01), and positive correlation was observed with WHO-class (r = 0.79; p < 0.001). Moreover, BNP levels were also correlated to PVR (r = 0.61; p < 0.01), PAP (r = 0.48; p < 0.05), and RAP (r = 0.78; p < 0.01), and were inversely related to cardiac index (r = –0.48; p < 0.05).

CONCLUSIONS: Our data suggest that plasma BNP levels are closely related to the functional impairment of PPH patients and parallel the extent of pulmonary hemodynamic changes and right heart failure. Serial measurements of plasma BNP concentrations may help improve the management of PPH patients.

Abbreviations and Acronyms
  ANP = atrial natriuretic peptide
  BNP = brain natriuretic peptide
  CO = cardiac output
  PAP = pulmonary artery pressure
  peak VO2 = peak oxygen uptake
  PPH = primary pulmonary hypertension
  PVR = pulmonary vascular resistance
  RAP = right atrial pressure
  SvO2 = mixed venous oxygen saturation
  WHO-class = World Health Organization functional class
  6 MW = 6-min-walk distance




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