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Kim, Kim, Lee, and Chung: The Correlation of Brain Natriuretic Peptide (BNP), Pulmonary Arterial Pressure, and St. George Respiratory Questionnaire (SGRQ) and Their Changes with a Trial of an Angiotensin Converting Enzyme Inhibitor
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 68(5): 273-279.

Published online: 31 May 2010

DOI: https://doi.org/10.4046/trd.2010.68.5.273

The Correlation of Brain Natriuretic Peptide (BNP), Pulmonary Arterial Pressure, and St. George Respiratory Questionnaire (SGRQ) and Their Changes with a Trial of an Angiotensin Converting Enzyme Inhibitor

Myung-A Kim, M.D.1, 2, Deog-Kyeom Kim, M.D.1, 2, Chang-Hoon Lee, M.D.1, 2, Hee Soon Chung, M.D.1, 2

1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.

Address for correspondence: Hee Soon Chung, M.D., Ph.D. Department of Internal Medicine, Seoul National University Boramae Medical Center, 425, Shindaebang 2-dong, Dongjak-gu, Seoul 156-707, Korea. Phone: 82-2-870-2211, Fax: 82-2-870-3866, heechung@snu.ac.kr

Received 15 April 2010       Accepted 21 April 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Pulmonary hypertension is considered as a poor prognosis factor in patients with chronic obstructive pulmonary disease (COPD). There has been reported brain natriuretic peptide (pro-BNP) is related with increased right ventricular (RV) workloads. However, there are few studies that evaluate the relationship between BNP and pulmonary arterial pressure (PAP), RV function and St. George Respiratory Questionnaire (SGRQ) score in patients with COPD, and the effects of angiotensin converting enzyme inhibitor (ACEI) on these parameters.

Methods

Pulmonary function test, echocardiography, blood BNP, and SGRQ score were evaluated in stabilized moderate degree COPD patients (FEV1/FVC<70%, 50%≤FEV1<80%) aged 45 years and over, without worsening of symptoms within recent 3 months. After treating with ramipril 10 mg for 3 months, the same evaluation was repeated.

Results

Twenty-two patients were included in this study. BNP was significantly correlated with PAP (Pearson coefficient ρ=0.51, p=0.02), but not with RV ejection fraction (EF) and predicted FEV1%. The values for predicted FEV1% showed significant correlation with SGRQ total score and activity score, but not with BNP or PAP. After ramipril treatment, PAP showed significant decrease (42.8±8.1 vs. 34.5±4.5 mm Hg p=0.0003), tricuspid annular plane systolic excursion significant increase (21.5±3.3 vs. 22.7±3.1 mm p=0.009). BNP showed a tendency to decrease without statistical significance (40.8±59.6 vs. 18.0±9.1 pg/mL p=0.55). SGRQ scores showed no significant change.

Conclusion

BNP showed significant correlation with resting PAP, which means BNP could be used as markers for pulmonary hypertension. Treatment with ACEI didn't show significant change in the level of BNP, while pulmonary hypertension and RV function were improved.

Keywords: Natriuretic Peptide, Brain, Pulmonary Disease, Chronic Obstructive, Hypertension, Pulmonary, Angiotensin-Converting Enzyme Inhibitors

Figures and Tables

Figure 1
The relationship between brain natriuretic peptide (BNP) level and pulmonary artery pressure (PAP). BNP was significantly correlated with PAP (p=0.02).
trd-68-273-g001
Figure 2
The relationship between FEV1% and St. George Respiratory Questionnaire (SGRQ) total score. FEV1% predicted was significantly correlated with SGRQ total score (SGRQ score=104.3-1.16×FEV1% predicted, p=0.03).
trd-68-273-g002
Figure 3
The relationship between FEV1 and brain natriuretic peptide (BNP) levels or pulmonary artery pressure (PAP). There was no significant correlation between FEV1% and BNP level or PAP (sPAP=44.6-0.04×FEV1% predicted, p=0.83; BNP=-26.1+1.5×FEV1% predicted, p=0.28).
trd-68-273-g003
Table 1
Baseline characteristics of study subjects
trd-68-273-i001

BMI: body mass index; FEV1: forced expiratory volume for a second; FVC: forced vital capacity; DLCO: CO diffusing capacity; LV: left ventricular; RV: right ventricular; TAPSE: tricuspid annular plane systolic excursion; BNP: brain natriuretic peptide; SGRQ: St. George Respiratory Questionnaire.

Table 2
The changes of echocardiographic variables, the level of BNP, and SGRQ score
trd-68-273-i002

BNP: brain natriuretic peptide; SGRQ: St. George Respiratory Questionnaire; LV: left ventricular; RV: right ventricular; TAPSE: tricuspid annular plane systolic excursion.

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