N-terminal pro–B-type natriuretic peptide for monitoring after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

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Background

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.

Methods

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.

Results

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/cm5 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/cm5; 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 (rrs = 0.43, p = 0.002) and PVR (rrs = 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).

Conclusions

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.

Section snippets

Study population

The present study included 51 consecutive patients who were treated by BPA at the Kerckhoff Heart and Thorax Center and completed a 6-month follow-up (6-MFU) after the final BPA treatment between March 2014 and March 2017. Pre- and post-procedural management data of the patients were recently published.6, 18 In brief, clinical examination, echocardiography, 12-lead electrocardiography (ECG), laboratory tests, 6-minute walk tests, ventilation–perfusion scan, computed tomographic (CT)

Results

Clinical and procedural characteristics of all 51 patients (28 women, 23 men; age [mean ± SD] 63.1 ± 11.5 years) enrolled in the study are presented in Table 1. The indication for the BPA therapy was a technically inoperable status due to peripheral lesions in 47 (92.2%) patients and a status after PEA with insufficient effects on hemodynamics and clinical parameters in 4 patients (7.8%) (Figure 1).

At baseline, 49 (96.1%) patients were in World Health Organization functional class (WHO FC)

Discussion

Practical experience with BPA, including both beneficial improvements and negative side effects, has accumulated over the last decade.6, 8, 9, 15, 18, 20, 21 BPA is a safe procedure, with pulmonary reperfusion edema and vessel injuries being the leading complications.7, 21 Published data on the effect of BPA on pulmonary hemodynamics are quite heterogeneous, with a broad range of results concerning the reduction of PVR and mean PAP after BPA21; however, right ventricular function and reverse

Disclosure statement

C.B.W. received consultant honoraria and/or speaker fees from Actelion, Bayer AG, MSD, Pfizer and BTG; M.H. received lecture honoraria from Daiichi-Sankyo and Pfizer. T.K. received speaker fees from Abbott. S.G. received speaker fees from Actelion, Bayer, GSK and Pfizer; A.R. received lecture honoraria from Astra Zeneca, Boehringer Ingelheim and Pfizer-Bristol-Myers Squibb; C.W.H. received lecture or consulting honoraria from Astra Zeneca, Bayer, Boehringer Ingelheim, GSK, Daiichi-Sankyo and

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    These authors have contributed equally to this study.

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