Biomarkers in clinical management of pulmonary hypertension: has the emperor no clothes? A call for action

[...]as a marker of myocardial stress and myocardial dysfunction, BNP/NT-proBNP (even if with quite variable and low specificity for PH) is the only biochemical marker acknowledged forboth thedaily clinic and for research studies, being part of the multidimensional management of PH patients that current guidelines recommend (1). [...]a main issue seems to be focusing research on the changes in biochemical markers occurring during the frequent episodes of clinical worsening and increase in mean pulmonary arterial pressure (PAP) that these kinds of patients often experience, whereas it should be to find out a number of factors that are able to predict these kinds of events. [...]in atrial fibrillation, a lifesaving treatment as oral anticoagulation is given on the basis of two scores, such as CHA2 DS2 VASC and HAS-BLED, that are strong predictors of cerebrovascular events and hemorrhagic risk, respectively (20). [...]we argue a call for identifying a clinical score, including biochemical markers (among these, BNP and NT-proBNP) in PH to be highly reasonable, and that this tool could conceivably warrant a progress in the management of patients with arterial PH (i.e.,group I), including many of the other pH patient groups.