1. Brain Natriuretic Peptide is a Prognostic Parameter in Chronic Lung Disease Hanno H. Leuchte, Rainer A. Baumgartner, Michal El Nounou, Michael Vogeser, Claus Neurohr,Michael Trautnitz, and Juergen Behr Division of Pulmonary Diseases, Department of Internal Medicine I, and Department of Clinical Chemistry, Ludwig Maximilians University, Klinikum Grosshadern, Munich, Germany Am J Respir Crit Care Med Vol 173. pp 744–750, 2006

2. Background 1.Hypoxemia 2.Pulmonary vasoconstriction 3.Pulmonary hypertension 4.Right ventricular hypertrophy 5.Impaired cardiac function

3. Background BNP BNP Left ventricular heart failure Left ventricular heart failure Pulmonary arterial hypertension with CLD Pulmonary arterial hypertension with CLD BNP & CLD BNP & CLD Prognostic marker Prognostic marker Screening parameter of pulmonary hypertension Screening parameter of pulmonary hypertension

4. Methods Prospective study of 176 patients between March 2001 and June 2005 Prospective study of 176 patients between March 2001 and June 2005 Patients who were scheduled for Rt. Heart failure Patients who were scheduled for Rt. Heart failure Thromboemboic disease, Left heart failure Thromboemboic disease, Left heart failure PAP <35 mmHg : advanced or significant PH PAP <35 mmHg : advanced or significant PH Lung function testing, blood sampling and BNP study Lung function testing, blood sampling and BNP study

11. 0.85 0.88

12. 24.29 month 33.44 month 22.36 34.23

14. Discussion Elevated BNP levels predicted survival BNP was superior to predict mortality : severe hypoxemia, lung volumes Excluded significant Lt. heart disease Limitations : echocardiography patients who were scheduled for right heart catheter to rule out PH a broad spectrum of lung diseases and cannot conclude on the prevalence of PH in a distinct lung disease

15. Conclusion Plasma BNP : noninvasive detection of significant PH with high accuracy and can be suggested as a screening test. Plasma BNP : noninvasive detection of significant PH with high accuracy and can be suggested as a screening test. BNP allows an assessment of the relevance of PH and could serve as a useful BNP allows an assessment of the relevance of PH and could serve as a useful prognostic parameter in chronic lung disease. prognostic parameter in chronic lung disease.