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Lung

, Volume 196, Issue 3, pp 315–319 | Cite as

Effect of 6-min Walk Test on pro-BNP Levels in Patients with Pulmonary Arterial Hypertension

  • Vikas Pathak
  • Robert Aris
  • Brian C. Jensen
  • Wei Huang
  • Hubert James Ford
PULMONARY HYPERTENSION
  • 185 Downloads

Abstract

Background

Plasma pro-BNP (brain natriuretic peptide) levels are often elevated in response to right ventricular (RV) volume and pressure overload, parameters potentially affected by exercise. Plasma pro-BNP levels change in association with long-term changes in pulmonary hemodynamics, thereby serving as a potential biomarker in pulmonary arterial hypertension (PAH). The 6-min Walk Test (6MWT) and pro-BNP level are often checked in a single office visit. There is no universal standard for measuring Pro-BNP levels relative to the timing of the 6MWT. Based on the studies in normal subjects indicating that pro-BNP levels changes after exercise, we hypothesized that the pro-BNP might rise after the 6MWT in PAH patients, potentially impacting clinical decisions.

Methods

Patients at our center with WHO Group 1 PAH on active therapy at a stable dose for 30 days or more were enrolled. After resting the patient for 30 min, blood was drawn for baseline pro-BNP and a 6MWT was performed. Pro-BNP levels were drawn immediately after the 6MWT and 1 and 2 h later. Pro-BNP was measured using a commercially available ELISA kit. The levels before exercise and after exercise were compared using student’s paired t tests.

Results

There were 17 females and 3 male subjects. The mean age was 53 ± 11 years. Seven patients had systemic lupus erythematosus-related PAH, six had idiopathic PAH, three had scleroderma, three had portopulmonary hypertension, and one had HIV-related PAH. The mean PA pressure was 50 ± 15 mmHg with a mean pulmonary vascular resistance of 10 ± 4 Wood units. The majority of the patients were on multimodality PAH therapy, including parenteral prostacyclins. Mean 6MWT distance was 377 ± 140 m. In 14/20 patients, the pro-BNP level increased immediately after the 6MWT; in 12/20 patients, the pro-BNP level was elevated at 1 h post exercise. In the majority of the patients, the pro-BNP fell to baseline 2 h post 6MWT.

Conclusion

There appears to be a trend of pro-BNP level increasing immediately after exercise and continuing to be elevated at 1 h. Pro-BNP levels then return to baseline at 2 h post 6MWT.

Keywords

Pulmonary hypertension Pro-BNP Six-min walk test 

Notes

Author Contributions

VP: Study design, conducted the study, data collection, manuscript preparation. RA: Study design, manuscript preparation. BJ: Running the samples, manuscript preparation. WH: Running the samples, manuscript preparation. HJF: Study design, patient identification, manuscript preparation.

Funding

This study was funded by Division of pulmonary and critical care medicine, University of North Carolina at Chapel Hill.

Compliance with Ethical Standards

Conflict of interest

The authors report no real or potential conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care Medicine, Department of MedicineWakeMed Health and HospitalsRaleighUSA
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of MedicineUniversity of North CarolinaChapel HillUSA
  3. 3.Division of Cardiology and UNC McAllister Heart InstituteUniversity of North CarolinaChapel HillUSA

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