Serial plasma brain natriuretic peptide testing in clinical management of pulmonary arterial hypertension

Background: Pulmonary arterial hypertension (PAH) is a serious and often progressive disorder that results in right ventricular dysfunction and mortality. Brain natriuretic peptide (BNP) is a useful cardiac biomarker for left-side heart failure. Reports about serial plasma BNP levels in PAH are limited. The aim of this article is to report serial plasma BNP determination in 6 PAH patients, who received therapy based on one of the endothelin receptor antagonists, bosentan. Methods: Starting from September 2004 to September 2007, we enrolled 6 PAH patients (4 males, 2 females; mean age: 33 years) who received bosentan therapy. Four patients had been diagnosed with idiopathic pulmonary hypertension (IPAH) and two had PAH associated with systemic lupus erythematosus (SLE). All patients were in World Health Organization (WHO) functional class III. All the patients with IPAH received right-heart catheterization and acute vasoreactivity test with nitric oxide inhalation. Plasma BNP measurement, 6-min walk test, and echocardiographic evaluation of right ventricular function were performed regularly every 3 to 6 months and in case of clinical worsening. Results: There was no mortality for a mean follow-up period of 33 months. During the follow-up period, the BNP levels fluctuated. There was a decrease in plasma BNP after bosentan therapy. Right-heart catheterization, 6-min walk distance, and echocardiography results were also presented in this report. During follow-up, 3 IPAH patients received combination therapy due to disease progression, 2 patients developed pericardial effusion, and 2 patients had an elevation of plasma BNP level with deterioration of clinical conditions. Conclusion: There is an initial decrease in plasma BNP in PAH patients under treatment with oral bosentan. Serial measurement of plasma BNP may help clinical judgement and management in PAH.