The association of the N-terminal pro-brain-type natriuretic peptide response to exercise with disease severity in therapy-naive pulmonary arterial hypertension: a cohort study

Kutsch, J.; Faul, Christian; Scheidt, Wolfgang von; Schwaiblmair, Martin; Berghaus, Thomas M.

doi:10.1186/s12931-017-0712-9

Cited by 5 publications

(8 citation statements)

References 11 publications

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“…Decreases in NT-proBNP with endurance exercise, but increases with strength exercise, have been described in sedentary individuals [58]. However, KUTSCH et al [59] in a study of 63 patients, concluded that accounting for exercise-related changes in NT-proBNP did not improve correlation with other surrogate markers of disease.…”

Section: Bnp and Nt-probnp Considerations For Samplingmentioning

confidence: 99%

BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing?

et al. 2020

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Despite the advent of new therapies and improved outcomes in patients with pulmonary arterial hypertension (PAH), it remains a life-shortening disease and the time to diagnosis remains unchanged. Strategies to improve outcomes are therefore currently focused on earlier diagnosis and a treatment approach aimed at moving patients with PAH into a category of low-risk of 1-year mortality. B-type natriuretic peptide (BNP; or brain natriuretic peptide) and N-terminal prohormone of BNP (NT-proBNP) are released from cardiac myocytes in response to mechanical load and wall stress. Elevated levels of BNP and NT-proBNP are incorporated into several PAH risk stratification tools and screening algorithms to aid diagnosis of systemic sclerosis. We have undertaken a systematic review of the literature with respect to the use of BNP and NT-proBNP in PAH and the use of these biomarkers in the diagnosis and risk stratification of PAH, their relation to pulmonary haemodynamics and the potential for point-of-care testing to improve diagnosis and prognosis.

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Section: Bnp and Nt-probnp Considerations For Samplingmentioning

confidence: 99%

BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing?

et al. 2020

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“…Brain natriuretic peptide (BNP) is an established and widely used clinical parameter for heart function and failure, and ventricular remodelling. While BNP was shown being a prognostic marker in PAH [27], others ruled out the NT-proBNP response to exercise as a disease severity assessment marker of PAH [28]. No significant upregulation of BNP was detectable in the RV due to the application of different diets (Fig.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary arterial remodelling by deficiency of peroxisome proliferator-activated receptor-γ in murine vascular smooth muscle cells occurs independently of obesity-related pulmonary hypertension

et al. 2019

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Background Obesity is associated with cardiovascular complications, including pulmonary hypertension (PH). Reports suggest that peroxisome proliferator-activated receptor-γ (PPARγ) has direct action in preventing vascular remodelling in PH. Here we dissected the specific role of high-fat-diet (HFD)-induced obesity and vascular smooth muscle cell (VSMC)-PPARγ for remodelling of small pulmonary arteries. Methods Wild-type (WT) and VSMC-specific PPARγ-knockout (Sm Pparγ −/− ) mice were fed a low-fat-diet (LFD, 10% kcal from fat) or HFD (60% kcal from fat) for 24 weeks. Mice were metabolically phenotyped (e.g. weight development, insulin/glucose tolerance) at the beginning, and after 12 and 24 weeks, respectively. At 24 weeks additionally pulmonary pressure, heart structure, pulmonary vascular muscularization together with gene and protein expression in heart and lung tissues were determined. Results HFD increased right ventricular systolic pressure (RVSP) to a similar extent in WT and Sm Pparγ −/− mice. HFD decreased glucose tolerance and insulin sensitivity in both WT and Sm Pparγ −/− mice. Importantly, the increase in RVSP correlated with the degree of insulin resistance. However, VSMC-PPARγ deficiency increased pulmonary vascular muscularization independently of the diet-induced rise in RVSP. This increase was associated with elevated expression of early growth response protein 1 in heart and osteopontin in lung tissue. Conclusions Here we demonstrate a correlation of insulin resistance and pulmonary pressure. Further, deficiency of PPARγ in VSMCs diet-independently leads to increased pulmonary vascular muscularization.

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“…NT-proBNP levels have also been associated with clinical outcomes in patients with pre-capillary and post-capillary pulmonary hypertension. 19,20 In response to a pressure or volume overload, NT-proBNP levels are an immediate reflection of RV Figure 3 Incremental prognostic value of right ventricular NT-proBNP dichotomized by 1500 pg/mL in predicting hospitalization for heart failure in patients with Group I PAH. NT-proBNP, N-terminal pro B-type natriuretic peptide; ROC, receiver operating characteristic curve; RV, right ventricular.…”

Section: Discussionmentioning

confidence: 99%

“…NT‐proBNP, a cleavage product of BNP, is secreted from membrane granules of ventricular cardiomyocytes and is an established biomarker for the diagnosis of HF. NT‐proBNP levels have also been associated with clinical outcomes in patients with pre‐capillary and post‐capillary pulmonary hypertension 19,20 . In response to a pressure or volume overload, NT‐proBNP levels are an immediate reflection of RV dilatation and deterioration of systolic function 21 .…”

Section: Discussionmentioning

confidence: 99%

“…NT-proBNP levels have also been associated with clinical outcomes in patients with pre-capillary and post-capillary pulmonary hypertension. 19,20 In response to a pressure or volume overload, NT-proBNP levels are an immediate reflection of RV dilatation and deterioration of systolic function. 21 Parallel to the changes in pulmonary haemodynamics, NT-proBNP levels also correlate with functional parameters, including 6MWT, and are indicators of treatment efficacy.…”

Section: Discussionmentioning

confidence: 99%

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Right ventricular expression of NT‐proBNP adds predictive value to REVEAL score in patients with pulmonary arterial hypertension

et al. 2021

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AimsThe Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk scores differentiate survivals in patients with pulmonary arterial hypertension (PAH). However, measurements of N-terminal pro B-type natriuretic peptide (NT-proBNP) in the peripheral blood may not adequately reflect early-stage decompensated heart failure (HF). Given that right heart catheterization (RHC) can facilitate measurements of intracardiac NT-proBNP, in this study our aim was to evaluate the predictive role of right ventricular (RV) NT-proBNP measurements in patients with PAH. Methods and resultsWe prospectively collected intracardiac blood samples for NT-proBNP measurements from patients diagnosed with World Health Organization Group I PAH during RHC. Clinical information including the aetiology of PAH (idiopathic, connective tissue disease, or congenital heart disease) and REVEAL scores were recorded. The primary endpoint was hospitalization for decompensated HF; median duration of follow-up was 28 months. Among the 62 patients evaluated, 12 reached the designated endpoint. REVEAL risk scores were higher among patients hospitalized for HF. We detected no significant differences in plasma NT-proBNP levels in peripheral circulation, in the right atrium, or in pulmonary arterial blood; however, significantly higher levels of NT-proBNP were detected in the RV in patients diagnosed with PAH. RV NT-proBNP was a sensitive predictor (cut-off value 1500 pg/mL) of subsequent hospitalization for HF. Our findings indicate that RV NT-proBNP levels add predictive value to REVEAL scores with respect to future hospitalization due to HF. Conclusions Right ventricular NT-proBNP levels combined with REVEAL 2.0 could predict the development of subsequent HF in patients with PAH and may be a potential biomarker.

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The association of the N-terminal pro-brain-type natriuretic peptide response to exercise with disease severity in therapy-naive pulmonary arterial hypertension: a cohort study

Cited by 5 publications

References 11 publications

BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing?

BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing?

Pulmonary arterial remodelling by deficiency of peroxisome proliferator-activated receptor-γ in murine vascular smooth muscle cells occurs independently of obesity-related pulmonary hypertension

Right ventricular expression of NT‐proBNP adds predictive value to REVEAL score in patients with pulmonary arterial hypertension

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