Role of NT-proBNP and 6MWD in chronic thromboembolic pulmonary hypertension

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• 作者：Jay Suntharalingam ; Kimberley Goldsmith ; Mark Toshner ; Natalie Doughty ; Karen K. Sheares ; Rodney Hughes ; David Jenkins ; Joanna Pepke-Zaba
• 关键词：Natriuretic peptides ; Pulmonary endarterectomy ; Pulmonary hypertension ; Six minute walking distance ; Thromboembolism
• 刊名：Respiratory Medicine
• 出版年：2007
• 出版时间：November 2007
• 年：2007
• 卷：101
• 期：11
• 页码：2254-2262
• 全文大小：308 K

文摘

This study aims to evaluate the role of NT-proBNP and six minute walking distance (6MWD) in the pre- and post-operative assessment of subjects undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Subjects undergoing PEA between August 2004 and July 2006 were assessed at baseline and 3 months post-operatively with resting haemodynamics, NT-proBNP and 6MWD.

Results

A number of 111 subjects underwent surgery, of which 102 were included. 15 subjects died before their 3 month assessment. Non-survivors had significantly worse preoperative NT-proBNP and 6MWD (4728 pg/mL vs 1863 pg/mL, p=0.001, 182.4 m vs 263.5 m, p=0.001). Taking pre-operative cut-off values of 1200 pg/mL for NT-proBNP and 345 m for 6MWD, both tests had high negative predictive value for predicting mortality (97.3 % and 100 % , respectively). Amongst survivors, peri-operative changes in NT-proBNP and 6MWD correlated with changes in total pulmonary resistance (TPR) (r=0.49, p<0.001 and r=−0.46, p<0.001). Post-operatively, both NT-proBNP and 6MWD also correlated with mPAP (r=0.65, p<0.001 and r=−0.50, p<0.001) and PVR (r=0.63, p<0.001 and r=−0.47, p<0.001). The ability of NT-proBNP to predict persistent pulmonary hypertension was significantly confounded by age, but not gender, BMI or renal function.

Conclusions

Pre-operative evaluation with NT-proBNP and 6MWD helps risk-stratify patients prior to PEA. Post-operatively, both markers correlate with changes in disease burden and right ventricular function. These results suggest that both NT-proBNP and 6MWD offer effective ‘bedside’ tools for the long term follow up of patients with CTEPH.