NT-proBNP can be used to detect RV systolic dysfunction in pulmonary hypertension

¹ Scottish Pulmonary Vascular Unit, Western Infirmary, Glasgow, UK; and Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, UK
² Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, UK
³ BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
⁴ Scottish Pulmonary Vascular Unit, Western Infirmary, Glasgow, UK

^* To whom correspondence should be addressed. E-mail: apeacock{at}udcf.gla.ac.uk.

	Abstract

Right ventricular systolic dysfunction (RVSD) at baseline (pre-treatment) predicts early death in patients with pulmonary hypertension (PH). RVSD can, however, only be detected reliably by prohibitively invasive or expensive techniques. N-terminal B-type natriuretic peptide concentration ([NT-proBNP]) correlates with RV function in PH, however, an [NT-proBNP] threshold that indicates RVSD in individual patients has not previously been determined.

25 patients with PH (Pulmonary Arterial Hypertension (19) or Chronic Thromboembolic PH (6)) underwent Cardiovascular Magnetic Resonance (CMR) imaging and NTproBNP measurement at baseline. [NT-proBNP] was correlated against RV dimensions and ejection fraction (RVEF) measured directly by CMR imaging. The ability of NT-proBNP to detect RVSD (defined as a CMR-derived RV ejection fraction (RVEF) >2 standard deviations below control values) was tested and predictors of [NT-proBNP] identified.

[NT-proBNP] correlated negatively with RVEF. RVSD was present in 9/25 patients. An [NT-proBNP] threshold of 1685 pg·ml^-1 was sensitive (100 %) and specific (94 %) in detecting RVSD. RVEF and RV mass index independently predicted [NT-proBNP].

In PH, a baseline [NT-proBNP] >1685 ng·l^-1 suggests RVSD, and thus an increased risk of early death. NT-proBNP could prove useful as an objective, non-invasive means of identifying patients with PH who have RVSD at presentation.

This article has been cited by other articles:

				A. J. Peacock, R. Naeije, N. Galie, and L. Rubin End-points and clinical trial design in pulmonary arterial hypertension: have we made progress? Eur. Respir. J., July 1, 2009; 34(1): 231 - 242. [Abstract] [Full Text] [PDF]

				V. V. McLaughlin, D. B. Badesch, M. Delcroix, T. R. Fleming, S. P. Gaine, N. Galie, J. S. R. Gibbs, N. H. Kim, R. J. Oudiz, A. Peacock, et al. End Points and Clinical Trial Design in pulmonary arterial hypertension. J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S97 - 107. [Abstract] [Full Text] [PDF]

				J. Behr and J. H. Ryu Pulmonary hypertension in interstitial lung disease Eur. Respir. J., June 1, 2008; 31(6): 1357 - 1367. [Abstract] [Full Text] [PDF]