Platelet Derived Growth Factor (PDGF) and Bone Morphogenic Protein 4 (BMP4) Levels May Indicate Presence of Combined Pre and Post Capillary WHO Group II Pulmonary Hypertension

Purpose Combined pre and post capillary pulmonary hypertension phenotype of WHO group 2 (CPCPH) portends worse mortality in patients with heart failure (HF). Definitions for CPCPH are still evolving, and biomarkers may help identify patients with CPCPH. PDGF is a protein that acts on the regulation of cell growth and division, mesenchymal proliferation, tissue remodeling, and angiogenesis. Bone morphogenic protein 4 is part of the transforming growth factor-beta (TGF-b). We hypothesized that markers of vascular proliferation such as PDGF and BMP4 may be elevated in patients with CPCPH. Methods Samples were collected from patients with a diagnosis of left heart failure that underwent right heart catheterization. We defined CPCPH as patients with a pulmonary vascular resistance (PVR) > 3 woods units (WU), while patients with isolated precapillary PH (iPCPH) were defined with a PVR Results In patients with CPCPH, PDGF showed a twofold expression compared to iPCPH. The median PVR for patients with CPCPH was 5.7 WU (mean age 60, BMI of 29, 63% male) compared to 1.5 WU in the iPCPH group (mean age 60, BMI 28, 71% male).PGDF level was significantly higher in CPCPH compared to iPCPH(20 ng/ml vs 9.0 ng/ml). In patients with a BMP level Conclusion There is evidence that markers of vascular proliferation such as PDGF and BMP4 have a different expression in patients with CPCPH. This findings warrant further study of the relationship of vascular proliferation in patients with CPCPH WHO group 2 PH.