Pneumologie 2016; 70 - V98
DOI: 10.1055/s-0036-1572121

Novel biomarkers for risk stratification in pulmonary arterial hypertension

T Zelniker 1, L Uhlmann 2, S Spaich 1, J Friedrich 1, M Preusch 1, FJ Meyer 1, HA Katus 1, E Giannitsis 1
  • 1Abteilung für Kardiologie, Angiologie und Pneumologie, Universitätsklinik Heidelberg
  • 2Institut für Medizinische Biometrie und Informatik, Universitätsklinik Heidelberg

Background: Risk stratification in pulmonary arterial hypertension (PAH) is paramount to identify individuals at highest risk of death. So far, there are only limited parameters for prognostication in patients with PAH.

Materials & Methods: Ninety-five patients with confirmed PAH were included in the present analysis and followed for a total of 4 years. Blood samples were analyzed for serum levels of NT-proBNP, hsTnT, proANP, GDF-15, sFlt-1, and PlGF.

Results: Twenty-seven patients (28.4%) died during a follow-up of 4 years. Levels of all tested biomarkers except for PlGF were significantly elevated in non-survivors as compared to survivors. ROC analyses demonstrated that cardiac biomarkers had the highest power in predicting mortality. In particular, proANP exhibited the highest AUC followed by NT-proBNP and hsTnT. Furthermore, proANP and hsTnT had a significant additive prognostic value to the established markers in categorical and continuous net reclassification index. Moreover, cox regression revealed that proANP (HR 1.91), hsTnT (HR 1.41), echocardiographic RV-impairment (HR 1.30) and six minute walk test (HR 0.97 per 10 meters) remained as the only significant parameters in prognostication of mortality.

Conclusion: Our data suggest benefits of implementation of proANP and hsTnT as additive biomarkers for risk stratification in patients with PAH.