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(Circulation. 2000;102:865.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Plasma Brain Natriuretic Peptide as a Prognostic Indicator in Patients With Primary Pulmonary Hypertension
From the Division of Cardiology, Department of Medicine, National Cardiovascular Center (N. Nagaya, T.S., S.K., F.S., M.K., K.F., Y.O., N. Nakanishi, K.M.), and Research Institute, National Cardiovascular Center Research Institute (T.N., M.U., K.K.), Osaka, Japan.
Correspondence to Noritoshi Nagaya, MD, Division of Cardiology, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
Background—Plasma brain natriuretic peptide (BNP) level increases in proportion to the degree of right ventricular dysfunction in pulmonary hypertension. We sought to assess the prognostic significance of plasma BNP in patients with primary pulmonary hypertension (PPH).
Methods and Results—Plasma BNP was measured in 60 patients with
PPH at diagnostic catheterization, together
with atrial natriuretic peptide,
norepinephrine, and epinephrine. Measurements were
repeated in 53 patients after a mean follow-up period of 3 months.
Forty-nine of the patients received intravenous or oral
prostacyclin. During a mean follow-up period of 24 months, 18 patients
died of cardiopulmonary causes. According to
multivariate analysis, baseline plasma BNP was
an independent predictor of mortality. Patients with a supramedian
level of baseline BNP (
150 pg/mL) had a significantly lower survival
rate than those with an inframedian level, according to Kaplan-Meier
survival curves (P<0.05). Plasma BNP in survivors
decreased significantly during the follow-up (217±38 to 149±30 pg/mL,
P<0.05), whereas that in nonsurvivors increased
(365±77 to 544±68 pg/mL, P<0.05). Thus, survival was
strikingly worse for patients with a supramedian value of follow-up BNP
(180 pg/mL) than for those with an inframedian value
(P<0.0001).
Conclusions—A high level of plasma BNP, and in particular, a further increase in plasma BNP during follow-up, may have a strong, independent association with increased mortality rates in patients with PPH.
Key Words: natriuretic peptides • hypertension, pulmonary • mortality
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H. H. Leuchte, C. Neurohr, R. Baumgartner, M. Holzapfel, W. Giehrl, M. Vogeser, and J. Behr Brain Natriuretic Peptide and Exercise Capacity in Lung Fibrosis and Pulmonary Hypertension Am. J. Respir. Crit. Care Med., August 15, 2004; 170(4): 360 - 365. [Abstract] [Full Text] [PDF]
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M. McGoon, D. Gutterman, V. Steen, R. Barst, D. C. McCrory, T. A. Fortin, and J. E. Loyd Screening, Early Detection, and Diagnosis of Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines Chest, July 1, 2004; 126(1_suppl): 14S - 34S. [Abstract] [Full Text] [PDF]
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V. V. McLaughlin, K. W. Presberg, R. L. Doyle, S. H. Abman, D. C. McCrory, T. Fortin, and G. Ahearn Prognosis of Pulmonary Arterial Hypertension*: ACCP Evidence-Based Clinical Practice Guidelines Chest, July 1, 2004; 126(1_suppl): 78S - 92S. [Abstract] [Full Text] [PDF]
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R. J. Barst, M. McGoon, A. Torbicki, O. Sitbon, M. J. Krowka, H. Olschewski, and S. Gaine Diagnosis and differential assessment of pulmonary arterial hypertension J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 40S - 47S. [Abstract] [Full Text] [PDF]
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M. M. Hoeper, R. J. Oudiz, A. Peacock, V. F. Tapson, S. G. Haworth, A. E. Frost, and A. Torbicki End points and clinical trial designs in pulmonary arterial hypertension: Clinical and regulatory perspectives J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 48S - 55S. [Abstract] [Full Text] [PDF]
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S.M. Kawut and H.I. Palevsky New answers raise new questions in pulmonary arterial hypertension Eur. Respir. J., June 1, 2004; 23(6): 799 - 801. [Full Text] [PDF]
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A. Peacock, R. Naeije, N. Galie, and J.T. Reeves End points in pulmonary arterial hypertension: the way forward Eur. Respir. J., June 1, 2004; 23(6): 947 - 953. [Abstract] [Full Text] [PDF]
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J. Bergler-Klein, U. Klaar, M. Heger, R. Rosenhek, G. Mundigler, H. Gabriel, T. Binder, R. Pacher, G. Maurer, and H. Baumgartner Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis Circulation, May 18, 2004; 109(19): 2302 - 2308. [Abstract] [Full Text] [PDF]
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H. H. Leuchte, M. Holzapfel, R. A. Baumgartner, I. Ding, C. Neurohr, M. Vogeser, T. Kolbe, M. Schwaiblmair, and J. Behr Clinical significance of brain natriuretic peptide in primary pulmonary hypertension J. Am. Coll. Cardiol., March 3, 2004; 43(5): 764 - 770. [Abstract] [Full Text] [PDF]
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M. R. Wilkins Selective or Nonselective Endothelin Receptor Blockade in Pulmonary Arterial Hypertension Am. J. Respir. Crit. Care Med., February 15, 2004; 169(4): 433 - 434. [Full Text] [PDF]
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S. de Denus, C. Pharand, and D. R. Williamson Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone Chest, February 1, 2004; 125(2): 652 - 668. [Abstract] [Full Text] [PDF]
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A. Clerico and M. Emdin Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review Clin. Chem., January 1, 2004; 50(1): 33 - 50. [Abstract] [Full Text] [PDF]
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N. Kucher and S. Z. Goldhaber Cardiac Biomarkers for Risk Stratification of Patients With Acute Pulmonary Embolism Circulation, November 4, 2003; 108(18): 2191 - 2194. [Full Text] [PDF]
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N. Nagaya, H. Okumura, M. Uematsu, W. Shimizu, F. Ono, M. Shirai, H. Mori, K. Miyatake, and K. Kangawa Repeated inhalation of adrenomedullin ameliorates pulmonary hypertension and survival in monocrotaline rats Am J Physiol Heart Circ Physiol, November 1, 2003; 285(5): H2125 - H2131. [Abstract] [Full Text] [PDF]
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P. Pruszczyk, M. Kostrubiec, A. Bochowicz, G. Styczynski, M. Szulc, M. Kurzyna, A. Fijalkowska, A. Kuch-Wocial, I. Chlewicka, and A. Torbicki N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism Eur. Respir. J., October 1, 2003; 22(4): 649 - 653. [Abstract] [Full Text] [PDF]
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T. S. Mir, R. Laux, H. H. Hellwege, B. Liedke, C. Heinze, H. von Buelow, S. Laer, and J. Weil Plasma Concentrations of Aminoterminal Pro Atrial Natriuretic Peptide and Aminoterminal Pro Brain Natriuretic Peptide in Healthy Neonates: Marked and Rapid Increase After Birth Pediatrics, October 1, 2003; 112(4): 896 - 899. [Abstract] [Full Text] [PDF]
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J. G. Lainchbury, E. Campbell, C. M. Frampton, T. G. Yandle, M. G. Nicholls, and A. M. Richards Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath J. Am. Coll. Cardiol., August 20, 2003; 42(4): 728 - 735. [Abstract] [Full Text] [PDF]
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A. Torbicki, M. Kurzyna, P. Kuca, A. Fijalkowska, J. Sikora, M. Florczyk, P. Pruszczyk, J. Burakowski, and L. Wawrzynska Detectable Serum Cardiac Troponin T as a Marker of Poor Prognosis Among Patients With Chronic Precapillary Pulmonary Hypertension Circulation, August 19, 2003; 108(7): 844 - 848. [Abstract] [Full Text] [PDF]
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N. Kucher, G. Printzen, and S. Z. Goldhaber Prognostic Role of Brain Natriuretic Peptide in Acute Pulmonary Embolism Circulation, May 27, 2003; 107(20): 2545 - 2547. [Abstract] [Full Text] [PDF]
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N. Nagaya, N. Sasaki, M. Ando, H. Ogino, F. Sakamaki, S. Kyotani, and N. Nakanishi Prostacyclin Therapy Before Pulmonary Thromboendarterectomy in Patients With Chronic Thromboembolic Pulmonary Hypertension Chest, February 1, 2003; 123(2): 338 - 343. [Abstract] [Full Text] [PDF]
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T. S. Mir, S. Marohn, S. Laer, M. Eiselt, O. Grollmus, and J. Weil Plasma Concentrations of N-Terminal Pro-Brain Natriuretic Peptide in Control Children From the Neonatal to Adolescent Period and in Children With Congestive Heart Failure Pediatrics, December 1, 2002; 110(6): e76 - 76. [Abstract] [Full Text] [PDF]
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D. Chemla, V. Castelain, P. Herve, Y. Lecarpentier, and S. Brimioulle Haemodynamic evaluation of pulmonary hypertension Eur. Respir. J., November 1, 2002; 20(5): 1314 - 1331. [Abstract] [Full Text] [PDF]
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D. Shitrit, D. Bendayan, A. Bar-Gil-Shitrit, M. Huerta, B. Rudensky, G. Fink, and M. R. Kramer Significance of a Plasma D-dimer Test in Patients With Primary Pulmonary Hypertension Chest, November 1, 2002; 122(5): 1674 - 1678. [Abstract] [Full Text] [PDF]
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