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High N-terminal pro-brain natriuretic peptide levels and low diffusing capacity for carbon monoxide as independent predictors of the occurrence of precapillary pulmonary arterial hypertension in patients with systemic sclerosis.
Arthritis Rheum. 2008 Jan; 58(1):284-91.AR

Abstract

OBJECTIVE

To evaluate predictors of pulmonary arterial hypertension (PAH) in a prospective cohort of patients with systemic sclerosis (SSc).

METHODS

Routine clinical assessments as well as measurements of the diffusing capacity for carbon monoxide/alveolar volume (DLCO/VA) ratio and N-terminal pro-brain natriuretic peptide (NT-proBNP) level were performed in a prospective cohort of 101 SSc patients who did not have PAH or severe comorbidities. After a planned 36-month followup, we evaluated the predictive value of these parameters for the development of precapillary PAH, as demonstrated by cardiac catheterization, disease progression, and death. Criteria for cardiac catheterization were a systolic pulmonary artery pressure (PAP) of >40 mm Hg on echocardiography, a DLCO value of <50% without pulmonary fibrosis, and unexplained dyspnea.

RESULTS

Eight patients developed PAH, 29 had disease progression, and 10 died during a median followup of 29 months. Kaplan-Meier analysis identified the following baseline parameters as being predictors of PAH: DLCO/VA ratio <70% or <60% (P<0.01 for each comparison), elevated plasma NT-proBNP level (>97th percentile of normal; P = 0.005), echocardiographically estimated systolic PAP >40 mm Hg (P=0.08), and erythrocyte sedimentation rate >28 mm/hour (P=0.015). In multivariate analyses, an elevated baseline NT-proBNP level (hazard ratio [HR] 9.97 [95% confidence interval (95% CI) 1.69-62.42]) and a DLCO/VA ratio <60% (HR 36.66 [95% CI 3.45-387.6]) were predictors of the occurrence of PAH during followup. An increased NT-proBNP level together with a decreased DLCO/VA ratio of <70% was highly predictive of the occurrence of PAH during followup (HR 47.20 [95% CI 4.90-450.33]).

CONCLUSION

This prospective study identified a decreased DLCO/VA ratio and an increased NT-proBNP as predictors of PAH in SSc. Use of these markers should result in improved PAH risk stratification and allow earlier initiation of therapy.

Authors+Show Affiliations

René Descartes University, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. yannick.allanore@cch.aphp.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18163505

Citation

Allanore, Y, et al. "High N-terminal Pro-brain Natriuretic Peptide Levels and Low Diffusing Capacity for Carbon Monoxide as Independent Predictors of the Occurrence of Precapillary Pulmonary Arterial Hypertension in Patients With Systemic Sclerosis." Arthritis and Rheumatism, vol. 58, no. 1, 2008, pp. 284-91.
Allanore Y, Borderie D, Avouac J, et al. High N-terminal pro-brain natriuretic peptide levels and low diffusing capacity for carbon monoxide as independent predictors of the occurrence of precapillary pulmonary arterial hypertension in patients with systemic sclerosis. Arthritis Rheum. 2008;58(1):284-91.
Allanore, Y., Borderie, D., Avouac, J., Zerkak, D., Meune, C., Hachulla, E., Mouthon, L., Guillevin, L., Meyer, O., Ekindjian, O. G., Weber, S., & Kahan, A. (2008). High N-terminal pro-brain natriuretic peptide levels and low diffusing capacity for carbon monoxide as independent predictors of the occurrence of precapillary pulmonary arterial hypertension in patients with systemic sclerosis. Arthritis and Rheumatism, 58(1), 284-91. https://doi.org/10.1002/art.23187
Allanore Y, et al. High N-terminal Pro-brain Natriuretic Peptide Levels and Low Diffusing Capacity for Carbon Monoxide as Independent Predictors of the Occurrence of Precapillary Pulmonary Arterial Hypertension in Patients With Systemic Sclerosis. Arthritis Rheum. 2008;58(1):284-91. PubMed PMID: 18163505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High N-terminal pro-brain natriuretic peptide levels and low diffusing capacity for carbon monoxide as independent predictors of the occurrence of precapillary pulmonary arterial hypertension in patients with systemic sclerosis. AU - Allanore,Y, AU - Borderie,D, AU - Avouac,J, AU - Zerkak,D, AU - Meune,C, AU - Hachulla,E, AU - Mouthon,L, AU - Guillevin,L, AU - Meyer,O, AU - Ekindjian,O G, AU - Weber,S, AU - Kahan,A, PY - 2008/1/1/pubmed PY - 2008/3/11/medline PY - 2008/1/1/entrez SP - 284 EP - 91 JF - Arthritis and rheumatism JO - Arthritis Rheum. VL - 58 IS - 1 N2 - OBJECTIVE: To evaluate predictors of pulmonary arterial hypertension (PAH) in a prospective cohort of patients with systemic sclerosis (SSc). METHODS: Routine clinical assessments as well as measurements of the diffusing capacity for carbon monoxide/alveolar volume (DLCO/VA) ratio and N-terminal pro-brain natriuretic peptide (NT-proBNP) level were performed in a prospective cohort of 101 SSc patients who did not have PAH or severe comorbidities. After a planned 36-month followup, we evaluated the predictive value of these parameters for the development of precapillary PAH, as demonstrated by cardiac catheterization, disease progression, and death. Criteria for cardiac catheterization were a systolic pulmonary artery pressure (PAP) of >40 mm Hg on echocardiography, a DLCO value of <50% without pulmonary fibrosis, and unexplained dyspnea. RESULTS: Eight patients developed PAH, 29 had disease progression, and 10 died during a median followup of 29 months. Kaplan-Meier analysis identified the following baseline parameters as being predictors of PAH: DLCO/VA ratio <70% or <60% (P<0.01 for each comparison), elevated plasma NT-proBNP level (>97th percentile of normal; P = 0.005), echocardiographically estimated systolic PAP >40 mm Hg (P=0.08), and erythrocyte sedimentation rate >28 mm/hour (P=0.015). In multivariate analyses, an elevated baseline NT-proBNP level (hazard ratio [HR] 9.97 [95% confidence interval (95% CI) 1.69-62.42]) and a DLCO/VA ratio <60% (HR 36.66 [95% CI 3.45-387.6]) were predictors of the occurrence of PAH during followup. An increased NT-proBNP level together with a decreased DLCO/VA ratio of <70% was highly predictive of the occurrence of PAH during followup (HR 47.20 [95% CI 4.90-450.33]). CONCLUSION: This prospective study identified a decreased DLCO/VA ratio and an increased NT-proBNP as predictors of PAH in SSc. Use of these markers should result in improved PAH risk stratification and allow earlier initiation of therapy. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/18163505/High_N_terminal_pro_brain_natriuretic_peptide_levels_and_low_diffusing_capacity_for_carbon_monoxide_as_independent_predictors_of_the_occurrence_of_precapillary_pulmonary_arterial_hypertension_in_patients_with_systemic_sclerosis_ L2 - https://doi.org/10.1002/art.23187 DB - PRIME DP - Unbound Medicine ER -