Usefulness of serial N-terminal pro-B-type natriuretic peptide measurements for determining prognosis in patients with pulmonary arterial hypertension.

Previous studies have shown the prognostic benefit of N-terminal pro–brain natriuretic peptide (NT–pro-BNP) in pulmonary arterial hypertension (PAH) at time of diagnosis. However, there are only limited data on the clinical utility of serial measurements of the inactive peptide NT–pro-BNP in PAH. This study examined the value of serial NT–pro-BNP measurements in predicting prognosis PAH. We retrospectively analyzed all available NT–pro-BNP plasma samples in 198 patients who were diagnosed with World Health Organization group I PAH from January 2002 through January 2009. At time of diagnosis median NT–pro-BNP levels were significantly different between survivors (610 pg/ml, range 6 to 8,714) and nonsurvivors (2,609 pg/ml, range 28 to 9,828, p 15%/year was associated with survival. In conclusion, a serum NT–pro-BNP level ≥1,256 pg/ml at time of diagnosis identifies poor outcome in patients with PAH. In addition, a decrease in NT–pro-BNP of >15%/year is associated with survival in PAH.