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. 2022 Apr;13(2):73-80.
doi: 10.14740/cr1362. Epub 2022 Apr 5.

The Association of N-Terminal Pro-Brain Natriuretic Peptide With Time to Clinical Worsening in Hispanic Patients With Pulmonary Arterial Hypertension

Yacoub Khatab  1 , Sayed Reshad Ghafouri  2 , Haider Alkhateeb  3 , Debabrata Mukherjee  3 , Hernando Garcia  4 , Nils Patrick Nickel  5
Affiliations

The Association of N-Terminal Pro-Brain Natriuretic Peptide With Time to Clinical Worsening in Hispanic Patients With Pulmonary Arterial Hypertension

Yacoub Khatab et al. Cardiol Res. 2022 Apr.

Abstract

Background: Measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) level is an important parameter in the risk assessment of patients with pulmonary arterial hypertension (PAH). Data about the prognostic value of NT-proBNP in the Hispanic PAH population are lacking. Historically, clinical trials in PAH have only included a minority of Hispanic patients. It has been reported that baseline NT-proBNP levels differ between different ethnicities. Furthermore, NT-proBNP levels can be impacted by declining renal function, making its interpretation difficult regarding clinical decision making.

Methods: In a retrospective single-center cohort analysis, Hispanic patients with PAH had a baseline outpatient NT-proBNP level drawn during a period of clinical stability and were followed for 1 year to monitor for time to clinical worsening (TTCW). The association of baseline NT-proBNP and TTCW was assessed in patients with normal and abnormal renal function.

Results: A total of 26 patients (22%) met the clinical endpoint of clinical worsening. Twenty-seven patients (24%) had chronic kidney disease (CKD). At baseline NT-proBNP levels showed a significant inverse correlation with 6-min walk test (6MWD, r = -0.382, P = 0.02), and a significant positive correlation with renal function (r = 0.273, P = 0.05). NT-proBNP levels did not correlate with age (r = 0.19, P = 0.11) or body mass index (BMI) (r = -0.292, P = 0.061). NT-proBNP levels of > 1,415 ng/L were significantly associated with shorter TTCW (P < 0.01) in all patients and in patients with CKD (P = 0.03). A stepwise increase in NT-proBNP levels by 100 ng/L was associated with a higher risk of meeting the clinical endpoint of TTCW in patients with normal renal function (hazard ratio (HR) = 1.8, P < 0.01) and CKD (HR = 1.5, P < 0.01).

Conclusions: In Hispanic patients with PAH, NT-proBNP is a valuable tool to predict 1-year TTCW, independent of renal function.

Keywords: Hispanics; N-terminal pro-brain natriuretic peptide; Pulmonary arterial hypertension.

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Conflict of interest statement

There is no potential conflict of interest to be declared by the authors.

Figures

Figure 1
Figure 1
NT-proBNP levels in patients with and without CKD. NT-proBNP: N-terminal pro-brain natriuretic peptide; CKD: chronic kidney disease.
Figure 2
Figure 2
Kaplan Meier Plot in all patients with NT-proBNP levels below or above 300 ng/L. TTCW: time to clinical worsening; NT-proBNP: N-terminal pro-brain natriuretic peptide.
Figure 3
Figure 3
Kaplan Meier Plot in all patients with NT-proBNP levels below or above 1,415 ng/L. TTCW: time to clinical worsening; NT-proBNP: N-terminal pro-brain natriuretic peptide.
Figure 4
Figure 4
Receiver operating characteristic curve analysis of baseline NT-proBNP levels to predict 1-year time to clinical worsening (TTCW) in all patients. NT-proBNP: N-terminal pro-brain natriuretic peptide; AUC: area under the curve; TTCW: time to clinical worsening.
Figure 5
Figure 5
Kaplan Meier Plot in patients with CKD and BNP levels below or above 1,415 ng/L. TTCW: time to clinical worsening; NT-proBNP: N-terminal pro-brain natriuretic peptide.
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References

    1. Galie N, Channick RN, Frantz RP, Grunig E, Jing ZC, Moiseeva O, Preston IR. et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J. 2019;53(1):1801889. doi: 10.1183/13993003.01889-2018. - DOI - PMC - PubMed
    1. Martinez-Rumayor A, Richards AM, Burnett JC, Januzzi JL Jr. Biology of the natriuretic peptides. Am J Cardiol. 2008;101(3A):3–8. doi: 10.1016/j.amjcard.2007.11.012. - DOI - PubMed
    1. Chin KM, Rubin LJ, Channick R, Di Scala L, Gaine S, Galie N, Ghofrani HA. et al. Association of N-terminal pro brain natriuretic peptide and long-term outcome in patients with pulmonary arterial hypertension. Circulation. 2019;139(21):2440–2450. doi: 10.1161/CIRCULATIONAHA.118.039360. - DOI - PMC - PubMed
    1. Nickel N, Golpon H, Greer M, Knudsen L, Olsson K, Westerkamp V, Welte T. et al. The prognostic impact of follow-up assessments in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. 2012;39(3):589–596. doi: 10.1183/09031936.00092311. - DOI - PubMed
    1. Battistoni A, Rubattu S, Volpe M. Circulating biomarkers with preventive, diagnostic and prognostic implications in cardiovascular diseases. Int J Cardiol. 2012;157(2):160–168. doi: 10.1016/j.ijcard.2011.06.066. - DOI - PubMed

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