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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

N-terminal pro–B-type natriuretic peptide for monitoring after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

  • Author Footnotes
    1 These authors have contributed equally to this study.
    Steffen D. Kriechbaum
    Correspondence
    Reprint requests: Steffen Kriechbaum, MD, Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. Telephone: +49 6032 996 2246. Fax: +49 6032 996 2313.
    Footnotes
    1 These authors have contributed equally to this study.
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
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  • Author Footnotes
    1 These authors have contributed equally to this study.
    Christoph B. Wiedenroth
    Footnotes
    1 These authors have contributed equally to this study.
    Affiliations
    Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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  • Jan Sebastian Wolter
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
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  • Regula Hütz
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
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  • Moritz Haas
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
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  • Andreas Breithecker
    Affiliations
    Department of Radiology, Gesundheitszentrum Wetterau, Bad Nauheim, Germany
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  • Fritz C. Roller
    Affiliations
    Department of Radiology, Justus Liebig University Giessen, Giessen, Germany
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  • Till Keller
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany
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  • Stefan Guth
    Affiliations
    Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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  • Andreas Rolf
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany

    Medical Clinic I, Division of Cardiology, Justus Liebig University Giessen, Giessen, Germany
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  • Christian W. Hamm
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany

    Medical Clinic I, Division of Cardiology, Justus Liebig University Giessen, Giessen, Germany
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  • Eckhard Mayer
    Affiliations
    Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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  • Christoph Liebetrau
    Affiliations
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt am Main, Germany

    Medical Clinic I, Division of Cardiology, Justus Liebig University Giessen, Giessen, Germany
    Search for articles by this author
  • Author Footnotes
    1 These authors have contributed equally to this study.
Published:December 08, 2017DOI:https://doi.org/10.1016/j.healun.2017.12.006

      Background

      Balloon pulmonary angioplasty (BPA) is an emerging interventional treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). The non-invasive monitoring of CTEPH patients is a clinical challenge. In this study we examined changes in N-terminal pro–B-type natriuretic peptide (NT-proBNP) in patients undergoing BPA for inoperable CTEPH and related them to peri-procedural success.

      Methods

      In this study we analyzed a total of 51 consecutive patients who underwent BPA treatment and completed a 6-month follow-up (6-MFU) between March 2014 and March 2017. Serum samples for NT-proBNP measurement were collected before every BPA and at 6-MFU.

      Results

      The 51 patients underwent 265 interventions involving angioplasty of a total of 410 vessels. The 6-month survival rate was 96.1%. The baseline (BL) mean pulmonary artery pressure (PAP) was 39.5 ± 12.1 mm Hg, pulmonary vascular resistance (PVR) was 515.8 ± 219.2 dynes/s/cm5 and the median NT-proBNP level was 820 (153 to 1,871.5) ng/liter. At BL, World Health Organization functional class (FC) was ≥III in 96.1% of the patients, whereas, at 6-MFU, 11.8% were in WHO FC ≥III. At 6-MFU, mean PAP (32.6 ± 12.6 mm Hg; p < 0.001), PVR (396.9 ± 182.6 dynes/s/cm5; p < 0.001) and NT-proBNP (159.3 [84.4 to 464.3] ng/liter; p < 0.001) levels were reduced. The decrease in NT-proBNP levels correlated with the decrease in mean PAP (rrs = 0.43, p = 0.002) and PVR (rrs = 0.50, p = 0.001). A reduction in the NT-proBNP level of 46% indicated a decrease in mean PAP of ≥25% (area under the curve [AUC] = 0.71) and a reduction of 61% indicated a decrease in PVR of ≥35% (AUC 0.77).

      Conclusions

      Our results demonstrate that NT-proBNP levels decrease after BPA, providing valuable evidence of procedural success. NT-proBNP measurement allows identification of patients who are BPA non-responders and may thus be a valuable adjunct in therapy monitoring.

      Graphical Abstract

      Keywords

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