(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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