Natriuretic peptides for the prediction of severely impaired peak VO2 in patients with lung disease

Maeder, Micha T.; Brutsche, Martin H.; Christ, Andreas; Reichlin, Tobias; Staub, Daniel; Noveanu, Markus; Breidthardt, Tobias; Potocki, Mihael; Mueller, Christian

doi:10.1016/j.rmed.2009.03.015

« Previous Next »Respiratory Medicine
Volume 103, Issue 9 , Pages 1337-1345, September 2009

Natriuretic peptides for the prediction of severely impaired peak VO₂ in patients with lung disease

Micha T. Maeder
- Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, Victoria 8008, Australia
- Corresponding author. Tel.: +61 3 8532 1111; fax: +61 3 8532 1100.
Martin H. Brutsche
- Division of Pneumology, Kantonsspital St. Gallen, Rorschacherstrasse, 9007 St. Gallen, Switzerland
Andreas Christ
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
Tobias Reichlin
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
Daniel Staub
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
Markus Noveanu
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
Tobias Breidthardt
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
Mihael Potocki
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
Christian Mueller
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland

Received 22 July 2008; accepted 20 March 2009. published online 17 April 2009.

Summary

Background

B-type natriuretic peptide (BNP) is a predictor of death in patients with lung disease. We hypothesised that in patients with lung disease, BNP and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) could predict a peak VO₂<15ml/kg/min, which is the proposed cut-off indicating an increased risk of perioperative complications during lung resection surgery.

Methods

BNP and NT-proBNP were measured in 85 patients with a variety of pulmonary pathologies undergoing cardiopulmonary exercise testing and fulfilling criteria for appropriate effort.

Results

BNP [69 (42–270) vs. 33 (15–65)pg/ml; p=0.001] and NT-proBNP [290 (129–1075) vs. 65 (21–129)pg/ml; p<0.001] were higher in patients with peak VO₂<15ml/kg/min (n=27) as compared to those with peak VO₂≥15ml/kg/min (n=58). Apart from the forced expiratory volume within the first second (FEV₁), body mass index (BMI), diabetes, and the alveolo-arterial oxygen pressure difference [D(A-a)O₂; only in the BNP model], BNP or NT-proBNP respectively were independent predictors of peak VO₂<15ml/kg/min. The areas under the receiver-operator-characteristics curve (AUC) for BNP and NT-proBNP to predict a peak VO₂<15ml/kg/min were 0.73 and 0.80 respectively. A five-item (BNP) or four-item (NT-proBNP) score including BMI, FEV₁, diabetes, D(A-a)O₂, and BNP/NT-proBNP had an AUC of 0.87 and 0.88 respectively for the prediction of peak VO₂<15ml/kg/min.

Conclusions

In patients with lung disease, BNP or NT-proBNP is independently associated with low peak VO₂. A simple score based on spirometry, blood gases and BNP or NT-proBNP has a high accuracy for the prediction of a peak VO₂<15ml/kg/min.

Keywords: Natriuretic peptides, Peak oxygenconsumption, Lung resection, Cardiopulmonary exercise testing