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Characterization of Brain Natriuretic Peptide in Long-term Follow-up of Pulmonary Arterial Hypertension^*

^* From the Department of Internal Medicine I (Drs. Leuchte, Holzapfel, Baumgartner, Neurohr, and Behr), Division of Pulmonary Diseases, and the Department of Clinical Chemistry (Dr. Vogeser), Ludwig Maximilians University, Klinikum Grosshadern, Munich, Germany.

Correspondence to: Hanno H. Leuchte, MD, Division of Pulmonary Diseases, Department of Internal Medicine I, Ludwig Maximilians University, Klinikum Grosshadern, Munich, Marchioninistr 15, 81377 Munich, Germany; e-mail: Hanno.Leuchte{at}med.uni-muenchen.de

Study objectives: Pulmonary arterial hypertension (PAH) leads to substantial morbidity and mortality. Noninvasive parameters in the follow-up assessment of PAH could be helpful in clinical decision making. The brain natriuretic peptide (BNP) has been shown to correlate with the functional status and prognosis of these patients and could be a valuable parameter in this respect. The aim of our study was to investigate whether BNP levels could reflect clinical and hemodynamic changes, including the response to therapy during long-term follow-up in patients with PAH.

Study design: We measured pulmonary hemodynamics, functional parameters including the 6-min walk distance (6MWD), and plasma BNP levels at baseline and after a mean (± SEM) follow-up period of 12.6 ± 1.5 months in patients with PAH.

Results: In group A (n = 18), with decreasing BNP levels mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) decreased (PAP, 60.89 ± 3.44 to 53.47 ± 3.24 mm Hg; PVR, 1,207.47 ± 111.75 to 942.35 ± 103.15 dyne · s · cm^–5; p < 0.01) and 6MWD increased (408.24 ± 29.57 to 470 ± 25.54 m; p < 0.01). In group B (n = 12), with increasing BNP levels mean PAP and PVR increased (PAP, 52 ± 3.31 to 60.17 ± 5.03 mm Hg; PVR, 946.13 ± 115.35 to 1,236.6 ± 180.23 dyne · s · cm^–5; p < 0.01) and mean 6MWD decreased from 463.64 ± 27.77 to 367.27 ± 38.87 m (p < 0.05). Comparing groups revealed statistically significant differences regarding changes in PAP (group A, –11.58 ± 3.57%; group B, +13.29 ± 5.44%; p = 0.001) and PVR (group A, –19.21 ± 5.87%, group B, +30.35 ± 7.72%; p < 0.001). Correlations existed between the changes in BNP levels and pulmonary hemodynamics.

Conclusion: We concluded that BNP levels parallel changes in pulmonary hemodynamics and functional parameters, including the 6MWD, in PAH patients. Consequently, we suggest BNP as a parameter for the follow-up assessment of PAH patients.

Key Words: exercise • hypertension • natriuretic peptides • pulmonary

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