PT  - JOURNAL ARTICLE
AU  - Steffen D. Kriechbaum
AU  - Lillith Scherwitz
AU  - Christoph B. Wiedenroth
AU  - Felix Rudolph
AU  - Jan-Sebastian Wolter
AU  - Moritz Haas
AU  - Ulrich Fischer-Rasokat
AU  - Andreas Rolf
AU  - Christian W. Hamm
AU  - Eckhard Mayer
AU  - Stefan Guth
AU  - Till Keller
AU  - Stavros V. Konstantinides
AU  - Mareike Lankeit
AU  - Christoph Liebetrau
TI  - Mid-regional pro-atrial natriuretic peptide and copeptin as indicators of disease severity and therapy response in CTEPH
AID  - 10.1183/23120541.00356-2020
DP  - 2020 Oct 01
TA  - ERJ Open Research
PG  - 00356-2020
VI  - 6
IP  - 4
4099  - http://openres.ersjournals.com/content/6/4/00356-2020.short
4100  - http://openres.ersjournals.com/content/6/4/00356-2020.full
SO  - erjor2020 Oct 01; 6
AB  - Background Chronic thromboembolic pulmonary hypertension (CTEPH) leads to right heart failure. Pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA) restore pulmonary haemodynamics and allow cardiac recovery. This study examined the relationship of copeptin and mid-regional pro-atrial natriuretic peptide (MR-proANP) levels to disease severity and therapy response.Methods This observational cohort study included 125 patients (55 PEA/70 BPA) who underwent treatment and completed a 6-/12-month follow-up. Biomarkers, measured at baseline, prior to every BPA and at follow-up, were compared to 1) severe disease at baseline (right atrial pressure (RAP) ≥8 mmHg and cardiac index ≤2.4 L·min−1·m−2) and 2) optimal therapy response (no persistent pulmonary hypertension combined with a normalised RAP (mean PAP ≤25 mmHg, pulmonary vascular resistance (PVR) ≤3 WU and RAP ≤6 mmHg) or a reduction in mean PAP ≥25%, PVR ≥35% and RAP ≥25%).Results Severely diseased patients had higher levels of MR-proANP (320 (246–527) pmol·L−1 versus 133 (82–215) pmol·L−1; p=0.001) and copeptin (12.7 (7.3–20.6) pmol·L−1 versus 6.8 (4.4–12.8) pmol·L−1; p=0.015) at baseline than the rest of the cohort. At baseline, MR-proANP (area under the curve (AUC) 0.91; cut-off value 227 pmol·L−1; OR 56, 95% CI 6.9–454.3) and copeptin (AUC 0.70; cut-off value 10.9 pmol·L−1; OR 1.5, 95% CI 1.2–1.9) identified severely diseased patients. After PEA/BPA, levels of MR-proANP (99 (58–145) pmol·L−1; p<0.001) and copeptin (6.3 (3.7–12.6) pmol·L−1; p=0.009) decreased and indicated optimal therapy response (MR-proANP <123 pmol·L−1 (AUC 0.70) and copeptin <10.1 pmol·L−1 (AUC 0.58)).Conclusion MR-proANP and copeptin levels are affected in CTEPH and decrease after therapy. MR-proANP identifies a severe disease status and optimal therapy response.The assessment of cardiac stress and impact of therapy is crucial in CTEPH. Serum levels of MR-proANP are associated with haemodynamic disease severity and therapy response, and might thus support individualised patient management. https://bit.ly/2QKwb7x