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Comparison of brain natriuretic peptide (BNP) and NT-proBNP in screening for pulmonary arterial hypertension in patients with systemic sclerosis.
J Rheumatol. 2010 Oct; 37(10):2064-70.JR

Abstract

OBJECTIVE

To compare the performance of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc).

METHODS

Between January 2008 and March 2009, outpatients referred to our unit and satisfying LeRoy criteria for SSc were assessed for PAH. Doppler echocardiography, BNP measurement, and NT-proBNP measurement were done concomitantly for a complete clinical, instrumental, and biochemical evaluation. Right-heart catheterization was carried out in cases of suspected PAH [estimated pulmonary arterial pressure (PAP) ≥ 36 mm Hg; diffusion capacity for carbon monoxide (DLCO) ≤ 50% of predicted value; 1-year DLCO decline ≥ 20% in absence of pulmonary fibrosis; unexplained dyspnea].

RESULTS

One hundred thirty-five patients were enrolled (124 women, 11 men; 96 limited SSc, 39 diffuse SSc); precapillary PAH was found in 20 patients (15 limited SSc, 5 diffuse SSc). The estimated PAP correlated with both BNP (R = 0.3; 95% CI 0.14-0.44) and NT-proBNP (R = 0.3, 95% CI 0.14-0.45). BNP [area under the curve (AUC) 0.74, 95% CI 0.59-0.89] was slightly superior to NT-proBNP (AUC 0.63, 95% CI 0.46-0.80) in identification of PAH, with diagnosis cutoff values of 64 pg/ml (sensitivity 60%, specificity 87%) and 239.4 pg/ml (sensitivity 45%, specificity 90%), respectively. BNP (log-transformed, p = 0.032) and creatinine (p = 0.049) were independent predictors of PAH, while NT-proBNP was not (p = 0.50).

CONCLUSION

In our single-center study, the performance of BNP was slightly superior to that of NT-proBNP in PAH screening of patients with SSc, although normal levels of these markers do not exclude diagnosis. We observed that impaired renal function is associated with an increased risk of PAH in SSc. Further multicenter studies are needed to confirm our results (ClinicalTrials.gov ID NCT00617487).

Authors+Show Affiliations

Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Pavia, Italy. lorenzo.cavagna@unipv.itNo 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

20634241

Citation

Cavagna, Lorenzo, et al. "Comparison of Brain Natriuretic Peptide (BNP) and NT-proBNP in Screening for Pulmonary Arterial Hypertension in Patients With Systemic Sclerosis." The Journal of Rheumatology, vol. 37, no. 10, 2010, pp. 2064-70.
Cavagna L, Caporali R, Klersy C, et al. Comparison of brain natriuretic peptide (BNP) and NT-proBNP in screening for pulmonary arterial hypertension in patients with systemic sclerosis. J Rheumatol. 2010;37(10):2064-70.
Cavagna, L., Caporali, R., Klersy, C., Ghio, S., Albertini, R., Scelsi, L., Moratti, R., Bonino, C., & Montecucco, C. (2010). Comparison of brain natriuretic peptide (BNP) and NT-proBNP in screening for pulmonary arterial hypertension in patients with systemic sclerosis. The Journal of Rheumatology, 37(10), 2064-70. https://doi.org/10.3899/jrheum.090997
Cavagna L, et al. Comparison of Brain Natriuretic Peptide (BNP) and NT-proBNP in Screening for Pulmonary Arterial Hypertension in Patients With Systemic Sclerosis. J Rheumatol. 2010;37(10):2064-70. PubMed PMID: 20634241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of brain natriuretic peptide (BNP) and NT-proBNP in screening for pulmonary arterial hypertension in patients with systemic sclerosis. AU - Cavagna,Lorenzo, AU - Caporali,Roberto, AU - Klersy,Catherine, AU - Ghio,Stefano, AU - Albertini,Riccardo, AU - Scelsi,Laura, AU - Moratti,Remigio, AU - Bonino,Claudia, AU - Montecucco,Carlomaurizio, Y1 - 2010/07/15/ PY - 2010/7/17/entrez PY - 2010/7/17/pubmed PY - 2011/2/15/medline SP - 2064 EP - 70 JF - The Journal of rheumatology JO - J. Rheumatol. VL - 37 IS - 10 N2 - OBJECTIVE: To compare the performance of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc). METHODS: Between January 2008 and March 2009, outpatients referred to our unit and satisfying LeRoy criteria for SSc were assessed for PAH. Doppler echocardiography, BNP measurement, and NT-proBNP measurement were done concomitantly for a complete clinical, instrumental, and biochemical evaluation. Right-heart catheterization was carried out in cases of suspected PAH [estimated pulmonary arterial pressure (PAP) ≥ 36 mm Hg; diffusion capacity for carbon monoxide (DLCO) ≤ 50% of predicted value; 1-year DLCO decline ≥ 20% in absence of pulmonary fibrosis; unexplained dyspnea]. RESULTS: One hundred thirty-five patients were enrolled (124 women, 11 men; 96 limited SSc, 39 diffuse SSc); precapillary PAH was found in 20 patients (15 limited SSc, 5 diffuse SSc). The estimated PAP correlated with both BNP (R = 0.3; 95% CI 0.14-0.44) and NT-proBNP (R = 0.3, 95% CI 0.14-0.45). BNP [area under the curve (AUC) 0.74, 95% CI 0.59-0.89] was slightly superior to NT-proBNP (AUC 0.63, 95% CI 0.46-0.80) in identification of PAH, with diagnosis cutoff values of 64 pg/ml (sensitivity 60%, specificity 87%) and 239.4 pg/ml (sensitivity 45%, specificity 90%), respectively. BNP (log-transformed, p = 0.032) and creatinine (p = 0.049) were independent predictors of PAH, while NT-proBNP was not (p = 0.50). CONCLUSION: In our single-center study, the performance of BNP was slightly superior to that of NT-proBNP in PAH screening of patients with SSc, although normal levels of these markers do not exclude diagnosis. We observed that impaired renal function is associated with an increased risk of PAH in SSc. Further multicenter studies are needed to confirm our results (ClinicalTrials.gov ID NCT00617487). SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/20634241/Comparison_of_brain_natriuretic_peptide__BNP__and_NT_proBNP_in_screening_for_pulmonary_arterial_hypertension_in_patients_with_systemic_sclerosis_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=20634241 DB - PRIME DP - Unbound Medicine ER -