Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension

Background-Plasma brain natriuretic peptide (BNP) level increases in propor tion to the degree of right ventricular dysfunction in pulmonary hypertensi on. We sought to assess the prognostic significance of plasma BNP in patien ts with primary pulmonary hypertension (PPH), Methods and Results-Plasma BNP was measured in 60 patients with PPH at diag nostic catheterization, together with atrial natriuretic peptide, norepinep hrine, and epinephrine. Measurements were repeated in 53 patients after a m ean follow-up period of 3 months. Forty-nine of the patients received intra venous or oral prostacyclin. During a mean follow-up period of 24 months, 1 8 patients died of cardiopulmonary causes. According to multivariate analys is, baseline plasma BNP was an independent predictor of mortality. Patients with a supramedian level of baseline BNP (greater than or equal to 150 pg/ mL) had a significantly lower survival rate than those with an inframedian level, according to Kaplan-Meier survival curves (P<0.05). Plasma BNP in su rvivors decreased significantly during the follow-up (217+/-38 to 149+/-30 pg/mL, P<0.05), whereas that in nonsurvivors increased (365+/-77 to 544+/-6 8 pg/mL, P<0.05). Thus, survival was strikingly worse for patients with a s upramedian value of follow-up BNP (greater than or equal to 180 pg/mL) than for those with an inframedian value (P<0.0001). Conclusions-A high level of plasma BNP, and in particular, a further increa se in plasma BNP during follow-up, may have a strong, independent associati on with increased mortality rates in patients with PPH.