Soluble ST2 and N-terminal pro-Brain Natriuretic Peptide Combination

rediction of severity and outcome in pulmonary arterial hypertension (PAH) is important but often difficult, especially in childhood. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are considered useful biomarkers of PAH in pediatric and adult patients.1–4 Lammers et al, however, reported that BNP had limited sensitivity (57%) for predicting death or the need for transplantation.3 Because BNP and NT-proBNP are secreted from the ventricular tissue as a consequence of right heart failure, they may not be considered as symbolic biomarkers of PAH. Furthermore, several potential biomarkers such as matrix metalloproteinase 2 (MMP-2), tenascin-C (TNC), pentraxin 3 (PTX3), cyclophilin A, angiopoietin-2 (Ang-2), and soluble ST2 (sST2) have been recently reported to be present in patients with PAH,5–9 but have not been used in actual clinical practice because they have not yet been fully validated, and the optimal biomarker of PAH remains to be identified. The aim of the present study was to investigate which biomarkers are useful for predicting severity and outcome of pediatric PAH. Emphasizing published data on functional P