Original article: general thoracic
Plasma brain natriuretic peptide as a noninvasive marker for efficacy of pulmonary thromboendarterectomy

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Abstract

Background. Plasma brain natriuretic peptide (BNP), a cardiac hormone secreted mainly by the cardiac ventricles, has been shown to increase in proportion to the degree of cardiac overload. However, whether plasma BNP may serve as a marker for the efficacy of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension remains unknown.

Methods. Plasma BNP level was measured in 34 patients with chronic thromboembolic pulmonary hypertension before and 1 month after pulmonary thromboendarterectomy. Right heart catheterization was also performed before and 1 month after the operation.

Results. Preoperative plasma BNP level was significantly elevated in patients with chronic thromboembolic pulmonary hypertension compared with control patients (246 ± 40 vs 13 ± 2 pg/mL; p < 0.001; n = 34) and was positively correlated with total pulmonary resistance (r = 0.57; p < 0.001). After pulmonary thromboendarterectomy, plasma BNP level in survivors markedly decreased (220 ± 31 to 54 ± 9 pg/mL; p < 0.001; n = 32) in association with a reduction of total pulmonary resistance (15.6 ± 1.0 to 4.5 ± 0.3 Wood units; p < 0.001). The change in plasma BNP level was closely correlated with that in total pulmonary resistance (r = 0.63; p < 0.001). Importantly, a sustained elevation of plasma BNP (≥ 50 pg/mL) indicated the presence of residual pulmonary hypertension (≥ 5 Wood units) after operation (sensitivity = 73%; specificity = 81%).

Conclusions. Plasma BNP level was strongly associated with the severity of pulmonary hypertension in patients with chronic thromboembolic pulmonary hypertension and thereby may serve as a noninvasive marker for the 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.

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