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Brain Natriuretic Peptide Is a Prognostic Parameter in Chronic Lung Disease

Division of Pulmonary Diseases, Department of Internal Medicine I, and Department of Clinical Chemistry, Ludwig Maximilians University, Klinikum Grosshadern, Munich, Germany

Correspondence and requests for reprints should be addressed to Juergen Behr, M.D., Division of Pulmonary Diseases, Department of Internal Medicine I, Ludwig Maximilians University, Klinikum Grosshadern, Munich Marchioninistrasse 15, 81377 Munich, Germany. E-mail: juergen.behr{at}med.uni-muenchen.de

Rationale: The detection of pulmonary hypertension in patients with chronic lung disease has prognostic implications. The brain natriuretic peptide (BNP) has been suggested as a noninvasive marker for the presence and severity of pulmonary hypertension.

Objectives: We evaluated circulating BNP levels as a parameter for the presence and severity of pulmonary hypertension in patients with chronic lung disease.

Methods: BNP levels were measured in 176 consecutive patients with various pulmonary diseases. Right heart catheterization, lung functional testing, and a 6-min walk test were performed. The mean follow-up time was nearly 1 yr.

Measurements and Main Results: Significant pulmonary hypertension (mean pulmonary artery pressure > 35 mm Hg) was diagnosed in more than one-fourth of patients and led to decreased exercise tolerance and life expectancy. Elevated BNP concentrations identified significant pulmonary hypertension with a sensitivity of 0.85 and specificity of 0.88 and predicted mortality. Moreover, BNP served as a risk factor of death independent of lung functional impairment or hypoxemia in uni- and multivariate analysis.

Conclusion: We suggest BNP as a prognostic marker and as screening parameter for significant pulmonary hypertension in chronic lung disease.

Key Words: chronic obstructive pulmonary disease • fibrosis • hypertension, pulmonary • natriuretic peptide, brain

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