Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension: Data From the REVEAL Registry

Robert Frantz, Harrison W. Farber, David B. Badesch, C. Greg Elliott, Adaani E. Frost, Michael D. McGoon, Carol Zhao, David R. Mink, Mona Selej, Raymond L. Benza

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Methods: Patients were ≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vs high (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Results: Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vs low BNP (HR, 3.6; 95% CI, 3.0-4.2). BNP change analysis at ≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95% CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Conclusions: Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.

Original languageEnglish (US)
JournalChest
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Brain Natriuretic Peptide
Pulmonary Hypertension
Registries
Survival
Mortality
Biomarkers
Cardiac Catheterization
Disease Management
ROC Curve
Odds Ratio

Keywords

  • biomarkers
  • brain natriuretic peptide
  • mortality
  • pulmonary arterial hypertension
  • survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension : Data From the REVEAL Registry. / Frantz, Robert; Farber, Harrison W.; Badesch, David B.; Elliott, C. Greg; Frost, Adaani E.; McGoon, Michael D.; Zhao, Carol; Mink, David R.; Selej, Mona; Benza, Raymond L.

In: Chest, 01.01.2018.

Research output: Contribution to journalArticle

Frantz, Robert ; Farber, Harrison W. ; Badesch, David B. ; Elliott, C. Greg ; Frost, Adaani E. ; McGoon, Michael D. ; Zhao, Carol ; Mink, David R. ; Selej, Mona ; Benza, Raymond L. / Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension : Data From the REVEAL Registry. In: Chest. 2018.
@article{7933d3519f494279a41e5c03b0c1c92d,
title = "Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension: Data From the REVEAL Registry",
abstract = "Background: Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Methods: Patients were ≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vs high (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Results: Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vs low BNP (HR, 3.6; 95{\%} CI, 3.0-4.2). BNP change analysis at ≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95{\%} CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Conclusions: Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.",
keywords = "biomarkers, brain natriuretic peptide, mortality, pulmonary arterial hypertension, survival",
author = "Robert Frantz and Farber, {Harrison W.} and Badesch, {David B.} and Elliott, {C. Greg} and Frost, {Adaani E.} and McGoon, {Michael D.} and Carol Zhao and Mink, {David R.} and Mona Selej and Benza, {Raymond L.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.chest.2018.01.009",
language = "English (US)",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",

}

TY - JOUR

T1 - Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension

T2 - Data From the REVEAL Registry

AU - Frantz, Robert

AU - Farber, Harrison W.

AU - Badesch, David B.

AU - Elliott, C. Greg

AU - Frost, Adaani E.

AU - McGoon, Michael D.

AU - Zhao, Carol

AU - Mink, David R.

AU - Selej, Mona

AU - Benza, Raymond L.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Methods: Patients were ≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vs high (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Results: Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vs low BNP (HR, 3.6; 95% CI, 3.0-4.2). BNP change analysis at ≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95% CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Conclusions: Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.

AB - Background: Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Methods: Patients were ≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vs high (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Results: Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vs low BNP (HR, 3.6; 95% CI, 3.0-4.2). BNP change analysis at ≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95% CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Conclusions: Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.

KW - biomarkers

KW - brain natriuretic peptide

KW - mortality

KW - pulmonary arterial hypertension

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=85045940206&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85045940206&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2018.01.009

DO - 10.1016/j.chest.2018.01.009

M3 - Article

C2 - 29355551

AN - SCOPUS:85045940206

JO - Chest

JF - Chest

SN - 0012-3692

ER -