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

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/cm(5) 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/cm(5); 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 (r(rs) = 0.43, p = 0.002) and PVR (r(rs) = 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. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.