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Endothelin-1 and BNP Plasma Levels Predict Survival in Patients with Pulmonary Arterial Hypertension

Robert Frantz


Ivan Robbins


Louise Durst


D. E. Grill

Michael McGoon


J. C. Burnett

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Conference: 2008 International PHA Conference and Scientific Sessions

Release Date: 06.20.2008

Presentation Type: Abstracts

Frantz R.P.1, Robbins I.M.2, Durst L.A.1, Grill D.E.1, McGoon M.D.1, Burnett J.C.1
1. College of Medicine, Mayo Clinic, Rochester, MN, USA
2. Vanderbilt University, Nashville, TN, USA

BACKGROUNDBiomarkers in PAH may be useful in assessing prognosis.
METHODSPatients with Group I PAH (n=88) underwent measurement of plasma ET-1, Big-ET, BNP, N-terminal ANP and NE. Kaplan-Meier plots for time to combined endpoint of death or transplant were created. Multivariate analysis including neurohormones, WHO class and 6 minute walk distance was performed.
RESULTSAge 48 ± 14 years, 81% female, 90% idiopathic, 5% CTD, 5% congenital, 6 min walk distance 348 ± 130 m, WHO functional class I, II, III, IV: 5%, 35%, 50%, 10%, PA mean 60 ± 10 mm Hg, Cardiac index 2.2 ± 0.8 L/min/m2. Patients in the highest quartile of ET-1 or BNP had hazard ratios for death or transplant of 4.4 (95% CI 1.7-11.7, p = 0.003) and 2.9 (95% CI 1.35-6.4, p = 0.007) respectively. A trend was present for highest quartile of N-ANP (Hazard ratio 2.3, 95% CI 0.91-5.7, p = .08).
CONCLUSIONSElevated ET-1 or BNP plasma levels are independent risk factors for death or transplantation in PAH. Association of elevated ET-1 with adverse prognosis suggests participation of ET-1 in the progression of PAH. ET-1 levels would not be expected to be predictive of outcome in patients already treated with ET antagonists due to effects of those agents on ET-1 clearance. We confirm that BNP is predictive of outcome and add evidence to the rationale for measuring BNP and ET-1 in patients with PAH.

Endothelin-1 and BNP Plasma Levels Predict Survival in Patients with Pulmonary Arterial Hypertension