P837MR-proANP: a new biomarker of clinical and structural severity in pulmonary arterial hypertension.

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Purpose: Pulmonary arterial hypertension (PAH) is a rare debilitating condition that impairs survival. Biomarkers may offer the opportunity to monitor and predict prognosis in this disease. The MR-proANP is a vaso-regulative and natriuretic peptide. Its diagnostic and prognostic value is unknown in PAH.Our objective was to prospectively evaluate the correlation of MR-proANP with clinical, laboratorial and echocardiographic parameters in patients with PAH. Methods: This prospective study included consecutive patients (pts) with groups I and IV PAH (Dana Point) confirmed by right heart catheterization and followed-up in the PAH clinic. The blood panel screening included NT-proBNP and MR-proANP. Bidimentional and 3D echocardiography was performed to assess right (RV) and left ventricular function and RV speckle tracking strain and strain rate analysis was performed. Results: We included 20 pts, aged 56±15 years, 16 females. Mean pulmonary artery systolic pressure was 82±25 mmHg. Mean NT-proBNP was 2633ng/ml ranging 86-16873ng/ml and mean MR-proANP was 242.4±222.7pmol/l. The blood concentration of MR-proANP showed strong correlation with NT-proBNP (R=0.90, p<0.01) and varied directly with creatinine and cystatin C (p <0.01).Diastolic (R=0.63, p<0.01) and systolic RV dimensions (R=0.5, p=0.03) correlated directly with MR-proANP levels. Furthermore, LV telediastolic diameter showed an inverse correlation (R=-0.46, p=0.05) to the biomarker.The dimensions of the right (R=0.72, p<0.01) and left (R=0.6, p<0.01) atria also correlated directly with levels of MR-proANPClinical worsening requiring hospitalization within 2 months of follow-up shown to correlate with the levels of MR-proANP (R=0.47, p=0.04). Conclusions: This pioneer investigation of the MR-proANP role in PAH has shown that it has high correlation with right-sided dimensions and left atrial diameter. MR-proANP also correlated inversely with LV dimension that may an effect of ventricular interdependence, emphasizing its potential role in serologic evaluation of cardiac remodelling. We found it to be discriminative of short-term prognosis

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