Usefulness of B-type natriuretic peptide as a predictor of treatment outcome in pulmonary arterial hypertension.

Abstract

We examined the utility of early modulation B-type natriuretic peptide (BNP) levels in 20 pulmonary arterial hypertension patients as a marker of response to epoprostenol therapy. The baseline BNP level was 828+/-217 pg/mL. A total of 19 hospitalizations and one death occurred in nine patients during 11.0+/-1.8 months. At baseline, a trend toward higher BNP level was observed among the event-free (Group A) as compared with clinical event patients (Group B) (1090+/-372 vs. 510+/-235 pg/mL, respectively; p=0.08). After 3 months on epoprostenol, a significant reduction among Group A occurred while Group B demonstrated an increase (288+/-92 vs. 610+/-121 pg/mL, p=0.04). A comparison of percent reduction in BNP level demonstrated a -70+/-7% change among Group A and an 11+/-19% increase in Group B (p=0.005). A decrease in BNP level of > or =50% during the first 3 months on epoprostenol was strongly predictive of event-free survival (p=0.003). This investigation establishes the utility of BNP for predicting response to epoprostenol therapy in pulmonary arterial hypertension.