Original article: general thoracicPlasma brain natriuretic peptide as a noninvasive marker for efficacy of pulmonary thromboendarterectomy
Section snippets
Study patients
This study included 34 patients with CTEPH (13 men and 21 women; mean age, 49 years; age range, 22 to 64 years) who underwent pulmonary thromboendarterectomy from January 1996 to October 2000. The preoperative condition was New York Heart Association functional class III (n = 27) or IV (n = 7). The diagnosis of CTEPH was made on the basis of the previously reported procedure [12]. In brief, patients with clinical symptoms suggesting CTEPH underwent ventilation and perfusion lung scanning to
Elevation of preoperative plasma BNP level in patients with CTEPH
Preoperative plasma BNP level was significantly elevated in patients with CTEPH compared with control patients (246 ± 40 vs 13 ± 2 pg/mL, p < 0.001). Plasma BNP level increased significantly with the severity of New York Heart Association functional class (Fig 1). Preoperative plasma BNP level was positively correlated with mean pulmonary arterial pressure (r = 0.37; p < 0.05) and negatively with cardiac output (r = −0.57; p < 0.001), thus showing a strong positive correlation with total
Comment
In the present study, we demonstrated that (1) preoperative plasma BNP level increased with disease severity of CTEPH, (2) plasma BNP level decreased in association with a reduction of total pulmonary resistance by pulmonary thromboendarterectomy, and (3) a sustained elevation of postoperative BNP level indicated the presence of residual pulmonary hypertension after operation.
Pulmonary thromboendarterectomy has been shown to improve hemodynamic status and survival in patients with CTEPH 2, 3, 4
Acknowledgements
This work was supported in part by the research grant for cardiovascular disease (12C-2) from the Ministry of Health, Labor and Welfare, Osaka, Japan, the Uehara Memorial Foundation, Tokyo, Japan, and a grant from the Japan Cardiovascular Research Foundation, Osaka, Japan.
References (16)
- et al.
The natural history of pulmonary embolism
Clin Chest Med
(1984) - et al.
Experienced results with 150 pulmonary thromboendarterectomy operations over a 29-month period
J Thorac Cardiovasc Surg
(1993) - et al.
Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension
J Am Coll Cardiol
(1998) - et al.
The management of pulmonary hypertension secondary to chronic thromboembolic disease
Prog Cardiovasc Dis
(1994) - et al.
Blood oxygen measurements in the assessment of intracardiac left to right shuntsa critical appraisal of methodology
Am J Cardiol
(1980) - et al.
Operation for chronic pulmonary thromboembolism accompanied by thrombophilia in 8 patients
Ann Thorac Surg
(1998) - et al.
Chronic major vessel thrombo-embolic pulmonary hypertension
Circulation
(1990) - et al.
Long-term outcome after pulmonary thromboendarterectomy
Am J Respir Crit Care Med
(1999)