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Higher plasma cell-free DNA tracks with worse PAH survival

Key clinical point: Plasma levels of cell-free DNA may be a useful diagnostic and prognostic marker in patients with pulmonary artery hypertension.

Major finding: Survival after 5 years was about 65% in the lowest cell-free DNA tertile and 28% in the highest tertile.

Study details: A single-center, prospective study of 151 patients with pulmonary artery hypertension.

Disclosures: Dr. Brusca had no disclosures. The study received no commercial funding.

Commentary:

I was very excited to hear Dr. Brusca’s report on using cell-free (cf) DNA to track the severity of pulmonary artery hypertension and survival of these patients. I’m now using cfDNA frequently to monitor heart transplant patients, and the information it provides has been very valuable. But cfDNA may be even better suited to assessing patients with pulmonary artery hypertension (PAH) because it’s a vascular disease, and increases in cfDNA appears to reflect damage to the vascular endothelium. It’s a brilliant application of this technology. Brain natriuretic peptide and troponin are markers of right heart damage, but cfDNA appears to be able to track the progression of the vascular component of PAH. It appears to be the first disease-specific biomarker we have for PAH. It’s time to start routinely measuring levels of cfDNA in trials so we can gather more data on the clinical correlates of changing levels of this biomarker.

Raymond L. Benza, MD , professor of medicine at Temple University, Philadelphia, and program director for advanced heart failure at the Allegheny Health Network in Pittsburgh, made these comments in an interview. He has been a consultant to Actelion, Gilead, and United Therapeutics, and has received research funding from Bayer.