TY - JOUR
T1 - Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension
T2 - Data From the REVEAL Registry
AU - Frantz, Robert P.
AU - Farber, Harrison W.
AU - Badesch, David B.
AU - Elliott, C. Greg
AU - Frost, Adaani E.
AU - McGoon, Michael D.
AU - Zhao, Carol
AU - Mink, David R.
AU - Selej, Mona
AU - Benza, Raymond L.
N1 - Funding Information:
Other contributions: Third-party medical editorial assistance was provided by BlueMomentum, an Ashfield Company, part of UDG Healthcare plc, and was funded by Actelion Pharmaceuticals US, Inc.
Publisher Copyright:
© 2018 American College of Chest Physicians
PY - 2018/7
Y1 - 2018/7
N2 - Background: Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Methods: Patients were ≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vs high (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Results: Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vs low BNP (HR, 3.6; 95% CI, 3.0-4.2). BNP change analysis at ≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95% CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Conclusions: Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.
AB - Background: Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Methods: Patients were ≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vs high (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Results: Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vs low BNP (HR, 3.6; 95% CI, 3.0-4.2). BNP change analysis at ≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95% CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Conclusions: Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.
KW - biomarkers
KW - brain natriuretic peptide
KW - mortality
KW - pulmonary arterial hypertension
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85045940206&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045940206&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2018.01.009
DO - 10.1016/j.chest.2018.01.009
M3 - Article
C2 - 29355551
AN - SCOPUS:85045940206
SN - 0012-3692
VL - 154
SP - 126
EP - 135
JO - CHEST
JF - CHEST
IS - 1
ER -