Natriuretic Peptides as Predictors for the Diagnosis of Pulmonary Hypertension Secondary to Left Heart Disease and for the Assessment of Its Severity

Figures

• 

  Figure 1. Flowchart visualizing enrollment process. BNP, B-type natriuretic peptide; HF, heart failure; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; PH, pulmonary hypertension; RHC, right heart catheterization.

• 

  Figure 2. Prevalence of PH (A,B), and selected hemodynamic characteristics: PVR > 5 Wood units (C,D), CI ≤ 2.0 L/min/m2 (E,F), and mean PAP > 35 mmHg (G,H) across groups with different concentrations of BNP and NT-proBNP. p-values < 0.05 were considered significant. Groups not sharing a common letter (a,b,c,d) differed significantly in Holm-adjusted post hoc comparisons. The Cochran–Armitage trend test was calculated to assess presence of increasing trends across BNP and NT-proBNP strata (p for Cochran–Armitage trend test: A < 0.001; B < 0.001; C < 0.001; D 0.008; E 0.003; F 0.001; G < 0.001; H < 0.001). BNP, B-type natriuretic peptide; CI, cardiac index; mean PAP, mean pulmonary artery pressure; NT-proBNP, N-terminal pro-B-type natriuretic peptide; PH, pulmonary hypertension; PVR, pulmonary vascular resistance.

• 

  Figure 3. Restricted cubic spline demonstrating the nonlinear association between BNP (A), NT-proBNP (B) and the probability of pulmonary hypertension. The solid line represents the predicted values, and the shaded area indicates 95% confidence intervals. p-overall refers to the significance of the overall association, whereas p-nonlinearity assesses deviation from linearity. p-overall: A < 0.001; B < 0.001; p-nonlinearity: A < 0.001; B < 0.001. BNP, B-type natriuretic peptide; NT-proBNP, N-terminal pro-B-type natriuretic peptide.

• 

  Figure 4. Associations between BNP, NT-proBNP, and mean pulmonary artery pressure (mean PAP) (A,B), pulmonary vascular resistance (PVR) (C,D), pulmonary arterial wedge pressure (PAWP) (E,F), and cardiac index (CI) (G,H) modeled using restricted cubic splines. The solid line represents the predicted values, and the shaded area indicates 95% confidence intervals. p-overall refers to the significance of the overall association, whereas p-nonlinearity assesses deviation from linearity. p-overall: A < 0.001; B < 0.001; C < 0.001; D < 0.001; E < 0.001; F < 0.001; G < 0.001; H 0.101; p-nonlinearity: A < 0.001; B < 0.001; C < 0.001; D 0.001; E < 0.001; F < 0.001; G < 0.001; H 0.075. BNP, B-type natriuretic peptide; CI, cardiac index; mean PAP, mean pulmonary artery pressure; NT-proBNP, N-terminal pro-B-type natriuretic peptide; PAWP, pulmonary arterial wedge pressure; PVR, pulmonary vascular resistance.

• 

  Figure 5. Receiver operating characteristic (ROC) curves picturing the predictive value of BNP and NT-proBNP for pulmonary hypertension (A), pulmonary vascular resistance > 5 Wood units (B), cardiac index ≤ 2 L/min/m2 (C), and mean pulmonary artery pressure > 35 mmHg (D). p-values < 0.05 were considered significant. BNP, B-type natriuretic peptide; CI, cardiac index; NT-proBNP, N-terminal pro-B-type natriuretic peptide; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; ROC, receiver operating characteristic.