Risk stratification in chronic thromboembolic pulmonary hypertension patients after pulmonary endarterectomy. The role of brain natriuretic peptide and high-sensitivity troponin I.

Abstract

Natriuretic peptides are a simple, widely accessible and cost-effective tool for the assessment of disease severity in patients with pulmonary arterial hypertension. The potential prognostic value of these biomarkers has never been assessed to stratify the risk of chronic thromboembolic (CTEPH) patients after pulmonary endarterectomy (PEA). Do brain natriuretic peptide (BNP) and high-sensitivity troponin I (hs-TNI) plasma levels predict long-term prognosis after PEA, and do they provide prognostic information additional to persistent pulmonary hypertension (PH) after surgery (defined as mean pulmonary artery pressure >20 mmHg and pulmonary vascular resistance >2 WU)? The study included a total of 1176 consecutive CTEPH patients who underwent PEA from 1994 to 2024. Hemodynamic and biomarkers data were available in 1176 patients at baseline and in 867 patients at a first follow-up 3-6 months after PEA. At follow-up, 357 patients had normal BNP, 488 abnormal BNP, and 22 additionally had abnormal hs-TNI plasma levels. The proportion of patients in functional class WHO III-IV and with compromised exercise capacity increased over the 3 groups (the difference between the abnormal BNP group and the group with abnormality of both biomarkers did not reach statistical significance). During a subsequent median follow-up period of 54 months, 45 cardiac deaths occurred. Abnormal plasma levels of BNP after surgery were associated with a five-fold increased mortality at multivariable analysis adjusted for the presence of persistent PH. Plasma levels of BNP are robust prognostic parameters that provide additional information to the assessment of persistent PH in CTEPH patients who have undergone PEA.