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

Abstract

Aims: The 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 results: We 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.