The European Society of Cardiology
Plasma brain natriuretic peptide is a marker of right ventricular overload in pulmonary hypertension associated to HIV infection
a Division of Cardiology, Policlinico S Matteo Hospital, Piazza Golgi 1, 27100 Pavia, Italy
b Institute of Infectious Diseases, IRCCS S Matteo Hospital, Pavia, Italy
c Biometry and Clinical Epidemiology, IRCCS S Matteo Hospital, Pavia, Italy
* Correspondence: Stefano Ghio, Division of Cardiology, Policlinico S Matteo Hospital, Piazza Golgi 1, 27100 Pavia, Italy, Tel.: +39 382 503713; fax: +39 382 503159 (E-mail: s.ghio{at}smatteo.pv.it).
Abstract
AIMS: The levels of plasma brain natriuretic peptide (BNP) are known to be elevated in patients with primary pulmonary hypertension (PH). We sought to verify the sensitivity and specificity of plasma BNP levels for the diagnosis of PH in HIV infected patients.
METHODS AND RESULTS: Plasma N-terminal proBNP levels were measured in 16 patients with HIV disease and a confirmed diagnosis of PH and in 77 control HIV patients with no cardiac or pulmonary disease. All patients underwent an echocardiographic and Doppler examination focused on the evaluation of right ventricular (RV) geometry and function. An abnormal value of N-terminal proBNP (>153 pg/ml in males and >88 pg/ml in females) yielded a 91% specificity and a 81% sensitivity for the diagnosis of PH. Three PH patients with normal N-terminal but similar transtricuspidal and transpulmonary gradients in comparison to those with abnormal N-terminal pro-BNP had normal indices of RV function.
CONCLUSIONS: Abnormal plasma N-terminal proBNP levels are associated with good sensitivity and specificity to the diagnosis of PH in HIV patients. Normal values of N-terminal proBNP may be observed in PH patients with HIV infection, in the case the right ventricle is not dilated and has a normal systolic function.
Keywords Primary pulmonary hypertension; HIV infection; BNP; Echocardiography