Abstract 979 Dynamics of natriuretic peptides in response to physical exercise in chronic thromboembolic pulmonary hypertension (CTEPH)

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Dynamics of natriuretic peptides in response to physical exercise in chronic thromboembolic pulmonary hypertension (CTEPH)
S. Kriechbaum¹, J. Birmes¹, C. Wiedenroth², M. Adameit², S. Guth², F. Roller³, M. Rademann¹, U. Fischer-Rasokat¹, C. Liebetrau⁴, C. W. Hamm⁵, T. Keller⁶, A. Rieth¹, für die Studiengruppen: BioReg, SFB-CRC1213
¹Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; ²Thoraxchirurgie, Kerckhoff-Klinik GmbH, Bad Nauheim; ³Radiologie, Justus-Liebig Universität Gießen, Gießen; ⁴Kardiologie, CCB am AGAPLESION BETHANIEN KRANKENHAUS, Frankfurt am Main; ⁵Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; ⁶Franz-Groedel-Institut (FGI), Justus-Liebig-Universität Giessen, Bad Nauheim;
BACKGROUND: In chronic thromboembolic pulmonary hypertension (CTEPH) invasive right heart catheterization during physical exercise (eRHC) provides valuable information about right heart dysfunction in response to exercise. In this course, an increased right atrial pressure (RAP) indicates right ventricular backward failure. Natriuretic peptides are validated biomarkers of cardiac stress. Their measurement during physical exercise might be a noninvasive approach to determine right heart dysfunction in response to exercise. METHODS: In total, 100 CTEPH patients underwent hemodynamic assessment via eRHC. The serum levels of mid-regional pro-atrial natriuretic peptide (MR-proANP) and brain natriuretic peptide (BNP) were measured under resting conditions prior to exercise, at peak exercise, after return to rest and after two hours of recovery. The relation between biomarker levels and hemodynamic findings [mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), mean RAP] were assessed. RESULTS: The 100 patients underwent eRHC with a median peak workload of 50 (IQR 25 - 75) watt and a median exercise duration of 8.00 (IQR 7.1 – 10.6) minutes. During eRHC 30 (30%) patients reached their maximum exercise capacity (central venous oxygen saturation ≤30%). The mPAP [29 (IQR 23 - 45) mmHg to 58 (47 – 70) mmHg; p<0.001], the PVR [4.1 (IQR 2.6 – 7.0) WU to 4.5 (IQR 3.0 – 7.3) WU; p<0.001] and the RAP [5 (4 – 7) mmHg to 16 (11 – 20) mmHg; p<0.001] increased significantly during exercise. The serum levels of MR-proANP [131 (IQR 82 – 194) pg/ml to 155 (IQR 103 – 225) pg/ml; p<0.001] and BNP [45 (IQR 20 – 143) pg/ml to 54 (IQR 24 – 176) pg/ml; p<0.001] increased during peak exercise and returned to resting levels after recovery. The MR-proANP level correlated with RAP (r=0.61; p<0.001) and PVR (r=0.46; p<0.001) at rest and at peak exercise (RAP r=0.66, PVR r=0.50, both p<0.001). Furthermore, the relative increase of MR-proANP correlated with the relative increase of RAP (r=0.52; p<0.001). The BNP level correlated with RAP (r=0.48; p<0.001) and PVR (r=0.54; p<0.001) at rest and at peak exercise (RAP r=0.51, PVR r=0.57, both p<0.001). CONCLUSION: This study suggests natriuretic peptides as a diagnostic tool for the noninvasive assessment of exercise induced right heart stress in CTEPH. Particularly MR-proANP might serve as an indicator progressive right heart failure, which comes along with backward failure and consecutively limited exercise tolerance.
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