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N-terminal pro-brain natriuretic peptide as a diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium-channel blockers.
Arthritis Rheum. 2003 Dec; 48(12):3503-8.AR

Abstract

OBJECTIVE

To evaluate N-terminal pro-brain natriuretic peptide (NT-proBNP) as a marker of early pulmonary artery hypertension (PAH) and to study changes in the levels of this marker following treatment with dihydropyridine-type calcium-channel blocker (DTCCB) in patients with systemic sclerosis (SSc).

METHODS

We evaluated 40 consecutive SSc patients who had been hospitalized for followup care (mean +/- SD age 56 +/- 11 years and mean +/- SD duration of cutaneous disease 9 +/- 9 years; 27 with limited cutaneous and 13 with diffuse cutaneous disease) but who had no clinical symptoms of heart failure and had a normal left ventricular ejection fraction. At baseline, 10 patients had PAH, defined as a systolic pulmonary artery pressure (sPAP) >40 mm Hg, as measured by echocardiography. Levels of NT-proBNP were determined at baseline (after discontinuation of DTCCB treatment for 72 hours), after taking 3 doses of DTCCB following treatment reinitiation (assessment 1), and after 6-9 months of continuous DTCCB treatment (assessment 2) in the 20 patients who attended regular appointments (including the 10 patients with PAH at baseline).

RESULTS

At baseline, 13 patients had high NT-proBNP values for their ages. High NT-proBNP levels identified patients with PAH with a sensitivity of 90%, a specificity of 90.3%, a positive predictive value of 69.2%, and a negative predictive value of 96%. The NT-proBNP level correlated with the sPAP (r = 0.44; P = 0.006). By assessment 1, the number of patients with PAH and high levels of NT-proBNP had decreased from 9 of 10 to 2 of 10 (P = 0.02). This decrease was partially sustained at assessment 2 (4 of 10 patients; P = 0.06).

CONCLUSION

NT-proBNP is a useful biologic marker that can be used to diagnose early PAH in SSc patients without clinical heart failure. Measurement of NT-proBNP may be valuable for the evaluation of treatment with DTCCB and vasodilators in patients with PAH.

Authors+Show Affiliations

Paris V University, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France. yannick.allanore@cch.ap-hop-paris.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

14674001

Citation

Allanore, Y, et al. "N-terminal Pro-brain Natriuretic Peptide as a Diagnostic Marker of Early Pulmonary Artery Hypertension in Patients With Systemic Sclerosis and Effects of Calcium-channel Blockers." Arthritis and Rheumatism, vol. 48, no. 12, 2003, pp. 3503-8.
Allanore Y, Borderie D, Meune C, et al. N-terminal pro-brain natriuretic peptide as a diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium-channel blockers. Arthritis Rheum. 2003;48(12):3503-8.
Allanore, Y., Borderie, D., Meune, C., Cabanes, L., Weber, S., Ekindjian, O. G., & Kahan, A. (2003). N-terminal pro-brain natriuretic peptide as a diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium-channel blockers. Arthritis and Rheumatism, 48(12), 3503-8.
Allanore Y, et al. N-terminal Pro-brain Natriuretic Peptide as a Diagnostic Marker of Early Pulmonary Artery Hypertension in Patients With Systemic Sclerosis and Effects of Calcium-channel Blockers. Arthritis Rheum. 2003;48(12):3503-8. PubMed PMID: 14674001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - N-terminal pro-brain natriuretic peptide as a diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium-channel blockers. AU - Allanore,Y, AU - Borderie,D, AU - Meune,C, AU - Cabanes,L, AU - Weber,S, AU - Ekindjian,O G, AU - Kahan,A, PY - 2003/12/16/pubmed PY - 2004/1/15/medline PY - 2003/12/16/entrez SP - 3503 EP - 8 JF - Arthritis and rheumatism JO - Arthritis Rheum. VL - 48 IS - 12 N2 - OBJECTIVE: To evaluate N-terminal pro-brain natriuretic peptide (NT-proBNP) as a marker of early pulmonary artery hypertension (PAH) and to study changes in the levels of this marker following treatment with dihydropyridine-type calcium-channel blocker (DTCCB) in patients with systemic sclerosis (SSc). METHODS: We evaluated 40 consecutive SSc patients who had been hospitalized for followup care (mean +/- SD age 56 +/- 11 years and mean +/- SD duration of cutaneous disease 9 +/- 9 years; 27 with limited cutaneous and 13 with diffuse cutaneous disease) but who had no clinical symptoms of heart failure and had a normal left ventricular ejection fraction. At baseline, 10 patients had PAH, defined as a systolic pulmonary artery pressure (sPAP) >40 mm Hg, as measured by echocardiography. Levels of NT-proBNP were determined at baseline (after discontinuation of DTCCB treatment for 72 hours), after taking 3 doses of DTCCB following treatment reinitiation (assessment 1), and after 6-9 months of continuous DTCCB treatment (assessment 2) in the 20 patients who attended regular appointments (including the 10 patients with PAH at baseline). RESULTS: At baseline, 13 patients had high NT-proBNP values for their ages. High NT-proBNP levels identified patients with PAH with a sensitivity of 90%, a specificity of 90.3%, a positive predictive value of 69.2%, and a negative predictive value of 96%. The NT-proBNP level correlated with the sPAP (r = 0.44; P = 0.006). By assessment 1, the number of patients with PAH and high levels of NT-proBNP had decreased from 9 of 10 to 2 of 10 (P = 0.02). This decrease was partially sustained at assessment 2 (4 of 10 patients; P = 0.06). CONCLUSION: NT-proBNP is a useful biologic marker that can be used to diagnose early PAH in SSc patients without clinical heart failure. Measurement of NT-proBNP may be valuable for the evaluation of treatment with DTCCB and vasodilators in patients with PAH. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/14674001/N_terminal_pro_brain_natriuretic_peptide_as_a_diagnostic_marker_of_early_pulmonary_artery_hypertension_in_patients_with_systemic_sclerosis_and_effects_of_calcium_channel_blockers_ L2 - https://doi.org/10.1002/art.11345 DB - PRIME DP - Unbound Medicine ER -