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NT-proBNP can be used to detect right ventricular systolic dysfunction in pulmonary hypertension

¹ Scottish Pulmonary Vascular Unit, ² Glasgow Cardiac Magnetic Resonance Unit, and ³ BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.

CORRESPONDENCE: A. J. Peacock, Scottish Pulmonary Vascular Unit, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK. Fax: 44 1412116334. E-mail: apeacock{at}udcf.gla.ac.uk

Keywords: Magnetic resonance imaging, natriuretic peptide, pulmonary hypertension, right ventricular function

Received: July 20, 2006
Accepted November 20, 2006

Right ventricular systolic dysfunction (RVSD) at baseline (pre-treatment) predicts early death in patients with pulmonary hypertension (PH). However, RVSD can only be detected reliably by prohibitively invasive or expensive techniques. N-terminal B-type natriuretic peptide concentration ([NT-proBNP]) correlates with RV function in PH; however, an [NT-proBNP] threshold that indicates RVSD in individual patients has not previously been determined.

Twenty-five patients with PH (pulmonary arterial hypertension (n = 19) or chronic thromboembolic PH (n = 6)) underwent cardiovascular magnetic resonance (CMR) imaging and NT-proBNP measurement at baseline. [NT-proBNP] was correlated against RV dimensions and ejection fraction (RVEF) measured directly by CMR imaging. The ability of NT-proBNP to detect RVSD (defined as a CMR-derived RVEF >2 SDs below control values) was tested and predictors of [NT-proBNP] identified.

[NT-proBNP] correlated negatively with RVEF. RVSD was present in nine out of 25 patients. An [NT-proBNP] threshold of 1,685 pg·mL^–1 was sensitive (100%) and specific (94%) in detecting RVSD. RVEF and RV mass index independently predicted [NT-proBNP].

In pulmonary hypertension, a baseline N-terminal B-type natriuretic peptide concentration of >1,685 ng·L^–1 suggests right ventricular systolic dysfunction, and thus an increased risk of early death. N-terminal B-type natriuretic peptide could prove useful as an objective, noninvasive means of identifying patients with pulmonary hypertension who have right ventricular systolic dysfunction at presentation.

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