Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany.
Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
J Heart Lung Transplant. 2018 May;37(5):639-646. doi: 10.1016/j.healun.2017.12.006. Epub 2017 Dec 8.
Balloon pulmonary angioplasty (BPA) is an emerging interventional treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). The non-invasive monitoring of CTEPH patients is a clinical challenge. In this study we examined changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients undergoing BPA for inoperable CTEPH and related them to peri-procedural success.
In this study we analyzed a total of 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between March 2014 and March 2017. Serum samples for NT-proBNP measurement were collected before every BPA and at 6-MFU.
The 51 patients underwent 265 interventions involving angioplasty of a total of 410 vessels. The 6-month survival rate was 96.1%. The baseline (BL) mean pulmonary artery pressure (PAP) was 39.5 ± 12.1 mm Hg, pulmonary vascular resistance (PVR) was 515.8 ± 219.2 dynes/s/cm and the median NT-proBNP level was 820 (153 to 1,871.5) ng/liter. At BL, World Health Organization functional class (FC) was ≥III in 96.1% of the patients, whereas, at 6-MFU, 11.8% were in WHO FC ≥III. At 6-MFU, mean PAP (32.6 ± 12.6 mm Hg; p < 0.001), PVR (396.9 ± 182.6 dynes/s/cm; p < 0.001) and NT-proBNP (159.3 [84.4 to 464.3] ng/liter; p < 0.001) levels were reduced. The decrease in NT-proBNP levels correlated with the decrease in mean PAP (r = 0.43, p = 0.002) and PVR (r = 0.50, p = 0.001). A reduction in the NT-proBNP level of 46% indicated a decrease in mean PAP of ≥25% (area under the curve [AUC] = 0.71) and a reduction of 61% indicated a decrease in PVR of ≥35% (AUC 0.77).
Our results demonstrate that NT-proBNP levels decrease after BPA, providing valuable evidence of procedural success. NT-proBNP measurement allows identification of patients who are BPA non-responders and may thus be a valuable adjunct in therapy monitoring.
球囊肺动脉成形术（BPA）是一种新兴的治疗慢性血栓栓塞性肺动脉高压（CTEPH）的介入治疗选择。对 CTEPH 患者的非侵入性监测是一项临床挑战。在这项研究中，我们检测了接受不可手术 CTEPH 的 BPA 治疗的患者的 N 端脑利钠肽前体（NT-proBNP）变化，并将其与围手术期成功相关联。
在这项研究中，我们分析了 2014 年 3 月至 2017 年 3 月期间接受 BPA 治疗并完成 6 个月随访（6-MFU）的 51 例连续患者。在每次 BPA 治疗前后和 6-MFU 时采集 NT-proBNP 测量的血清样本。
51 例患者共进行了 265 次血管成形术介入治疗，共涉及 410 条血管。6 个月的生存率为 96.1%。基线（BL）平均肺动脉压（PAP）为 39.5 ± 12.1mmHg，肺血管阻力（PVR）为 515.8 ± 219.2 dynes/s/cm，中位 NT-proBNP 水平为 820（153 至 1871.5）ng/liter。BL 时，96.1%的患者世界卫生组织功能分类（FC）≥III 级，而在 6-MFU 时，11.8%的患者 FC≥III 级。在 6-MFU 时，平均 PAP（32.6 ± 12.6mmHg；p<0.001）、PVR（396.9 ± 182.6 dynes/s/cm；p<0.001）和 NT-proBNP（159.3[84.4 至 464.3]ng/liter；p<0.001）水平降低。NT-proBNP 水平的降低与平均 PAP（r=0.43，p=0.002）和 PVR（r=0.50，p=0.001）的降低相关。NT-proBNP 水平降低 46%表明平均 PAP 降低≥25%（曲线下面积[AUC]为 0.71），降低 61%表明 PVR 降低≥35%（AUC 0.77）。
我们的结果表明，BPA 后 NT-proBNP 水平降低，为手术成功提供了有价值的证据。NT-proBNP 测量可识别 BPA 无反应者，并可能成为治疗监测的有用辅助手段。
